RN Clinical Claims Analyst

CVS Health; Oklahoma City (OK); On-site; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Clinical Claim Review Nurse in Oklahoma City to review and evaluate clinical information for post-service claims, applying established clinical criteria and policies in line with regulatory requirements and plan benefits. The role requires an RN with 2–3 years of professional experience and strong analytical skills.

This full-time position offers a comprehensive benefits package including medical, dental, and vision coverage, paid time off, and retirement savings options.

Qualifications

• RN required.
• 2-3 years of professional RN experience or equivalent clinical experience.

Responsibilities

• Review and interpret clinical documentation from medical records or systems.
• Apply clinical criteria and policies for post-service claims.
• Coordinate clinical resolutions independently with clinician/MD support.
• Serve as a resource for customer service and claims processing teams.
• Train new staff and provide cross-training to existing team members.
• Identify trends and report discrepancies or potential fraud to leadership.
• Maintain compliance with applicable laws, regulations, and internal workflows.

Skills

Analytical skills

Communication skills

Education

Associate Degree in Nursing

Bachelor of Science in Nursing

Tools

Microsoft Office Suite

Utilization Management software

Job description

CVS Health is seeking a Clinical Claim Review Nurse in Oklahoma City to review and evaluate clinical information for post-service claims, applying established clinical criteria and policies in line with regulatory requirements and plan benefits. The role requires an RN with 2–3 years of professional experience and strong analytical skills.

This full-time position offers a comprehensive benefits package including medical, dental, and vision coverage, paid time off, and retirement savings options.