RN Clinical Claims Auditor & Trainer

CVS Health Corporation; Alabama; Hybride; USD 36 000 - 94 000; Plein temps

Avantages offerts par ce poste

Medical insurance

Dental insurance

Vision insurance

Paid time off

Résumé du poste

CVS Health Corporation in Alabama seeks a licensed RN to review and interpret clinical documentation, apply policies for post‑service claims, and coordinate resolutions with clinicians. You will train staff and support customer service and claims teams.

This full‑time role requires a BSN, active RN license in the state, 2–3 years of experience, and strong analytical skills to assess medical claims. Eligible for CVS Health bonus programs and a comprehensive benefits package.

Qualifications

• Active, unrestricted RN licensure in your state of residence.
• Bachelor's degree in Nursing (RN).
• 2–3 years of professional RN experience or equivalent clinical experience.
• Strong analytical skills to assess medical claims.

Responsabilités

• Review and interpret clinical documentation from medical records or systems.
• Apply clinical decision‑making to policies for post‑service claims.
• Coordinate clinical resolutions independently, with clinician support as needed.
• Act as a resource for customer service and claims processing teams.
• Train new staff and provide cross‑training to current team.
• Identify trends and flag discrepancies or potential fraud to leadership.
• Stay compliant with applicable laws, regulations, and internal workflows.

Connaissances

Analytical skills

Clinical judgement

Communication skills

Formation

RN licensure

Bachelor's degree in Nursing

Description du poste

CVS Health Corporation in Alabama seeks a licensed RN to review and interpret clinical documentation, apply policies for post‑service claims, and coordinate resolutions with clinicians. You will train staff and support customer service and claims teams.

This full‑time role requires a BSN, active RN license in the state, 2–3 years of experience, and strong analytical skills to assess medical claims. Eligible for CVS Health bonus programs and a comprehensive benefits package.