RN Clinical Claims Reviewer

CVS Health; Fulton (MS); On-site; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement savings

Job summary

CVS Health is seeking a Clinical Claim Review Nurse (RN) to review clinical documentation and apply policies to post-service claims. You will coordinate resolutions with clinicians, support customer service and claims teams, and train staff.

The role requires an RN license with 2–3 years of experience, strong analytical skills, and proficiency with Microsoft Office. This full-time position is in Mississippi and includes comprehensive benefits.

Qualifications

• RN nursing degree with active license
• 2-3 years of professional RN experience
• Strong analytical skills to assess medical claims
• Computer proficiency, Microsoft Office

Responsibilities

• Review and interpret clinical documentation from medical records or systems.
• Apply clinical criteria and policies to post-service claims.
• Coordinate clinical resolutions independently with clinician/MD support as needed.
• 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 report discrepancies or potential fraud to leadership.
• Stay current with applicable laws, regulations, and internal workflows.

Skills

RN

Analytical skills

Claims review

Customer service

Education

Associates Degree in Nursing

Bachelor of Science in Nursing preferred

Tools

Microsoft Office

Job description

CVS Health is seeking a Clinical Claim Review Nurse (RN) to review clinical documentation and apply policies to post-service claims. You will coordinate resolutions with clinicians, support customer service and claims teams, and train staff.

The role requires an RN license with 2–3 years of experience, strong analytical skills, and proficiency with Microsoft Office. This full-time position is in Mississippi and includes comprehensive benefits.