RN Clinical Claims Review Specialist

CVS Health; Alaska; On-site; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is hiring a Clinical Claim Review Nurse in Alaska. The role reviews clinical information and applies criteria to post-service claims, coordinating resolutions with clinicians as needed.

You will navigate multiple systems, ensure confidentiality, and support customer service and claims teams. The position requires an RN with 2–3 years of experience and strong analytical skills to assess medical claims.

Qualifications

• Must have RN license and 2-3 years of professional experience as an RN.
• Strong analytical skills to assess medical claims.

Responsibilities

• Review and interpret clinical documentation from medical records or systems.
• Apply clinical criteria and policies to post‑service claims.
• Coordinate clinical resolutions with clinicians/MDs as required.
• Serve as a resource for customer service and claims processing teams.
• Train new staff and provide cross-training to team members.
• Identify trends and report discrepancies or potential fraud to leadership.
• Stay current with laws, regulations and internal workflows to ensure compliance.

Skills

Analytical skills

Education

Associates Degree in Nursing

Bachelor of Science in Nursing

Job description

CVS Health is hiring a Clinical Claim Review Nurse in Alaska. The role reviews clinical information and applies criteria to post-service claims, coordinating resolutions with clinicians as needed.

You will navigate multiple systems, ensure confidentiality, and support customer service and claims teams. The position requires an RN with 2–3 years of experience and strong analytical skills to assess medical claims.