RN Clinical Claims Review - Post-Service Expert

CVS Health; Atlanta (GA); Sur place; USD 36 000 - 77 000; Plein temps

Résumé du poste

CVS Health in Atlanta, GA is seeking a Clinical Claim Review Nurse. The role requires an RN with 2–3 years of professional experience to review clinical documentation and apply policies for post-service claims.

The position is full-time, on-site, with a comprehensive benefits package. You will collaborate with clinicians, support customer service teams, and help ensure compliance with regulations while maintaining patient confidentiality.

Qualifications

• RN required with 2–3 years of professional experience.
• Strong analytical skills to assess medical claims.

Responsabilités

• Review and interpret clinical documentation from medical records to evaluate post-service claims.
• Apply clinical criteria and policies for claims in line with regulations and plan benefits.
• Coordinate clinical resolutions independently with clinician/MD support as needed.
• Serve as a resource for customer service and claims processing teams.
• Train new staff and provide cross-training to teammates.
• Identify trends and report discrepancies or potential fraud to leadership.
• Stay current with applicable laws and internal workflows to ensure compliance.

Connaissances

Analytical skills

Formation

Associates Degree in Nursing

Bachelor of Science in Nursing

Outils

Microsoft Suite

Description du poste

CVS Health in Atlanta, GA is seeking a Clinical Claim Review Nurse. The role requires an RN with 2–3 years of professional experience to review clinical documentation and apply policies for post-service claims.

The position is full-time, on-site, with a comprehensive benefits package. You will collaborate with clinicians, support customer service teams, and help ensure compliance with regulations while maintaining patient confidentiality.