RN Clinical Claims Analyst & Trainer

CVS Health Corporation; Nevada; Híbrido; USD 54.000 - 143.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical insurance

Dental insurance

Vision care

Descripción de la vacante

CVS Health Corporation is seeking a Registered Nurse to review and interpret clinical documentation, apply post-service criteria, and coordinate resolutions with clinicians and customer-service teams.

This full-time RN role requires licensure in the state of residence, a Nursing degree, and 2–3 years of clinical experience, with strong analytical skills to assess medical claims. Benefits include medical, dental, and vision coverage, and a comprehensive rewards package.

Formación

• Must have active current and unrestricted RN licensure in state of residence.
• Nursing degree (RN)
• A minimum of 2-3 years of professional experience as a licensed RN or equivalent clinical experience.
• Strong analytical skills to assess medical claims.

Responsabilidades

• Review and interpret clinical documentation obtained from medical records or systems.
• Apply clinical decision-making to utilize appropriate clinical criteria and policies for post-service claims
• Coordinate clinical resolutions independently, with clinician/MD support as required
• Act as a resource for customer service and claims processing teams
• Train new staff and provide cross-training to existing team members
• Identify trends and provide feedback to leadership if discrepancies or potential fraudulent activities are identified
• Remain current with applicable laws, regulations, and internal workflows to ensure full compliance with organizational and state-specific requirements

Conocimientos

Analytical skills

Clinical judgment

Educación

Bachelor's degree

Descripción del empleo

CVS Health Corporation is seeking a Registered Nurse to review and interpret clinical documentation, apply post-service criteria, and coordinate resolutions with clinicians and customer-service teams.

This full-time RN role requires licensure in the state of residence, a Nursing degree, and 2–3 years of clinical experience, with strong analytical skills to assess medical claims. Benefits include medical, dental, and vision coverage, and a comprehensive rewards package.