RN Clinical Claims Reviewer

CVS Health; Hartford (CT); On-site; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical coverage

Dental & Vision

Paid time off

Retirement plan

Job summary

CVS Health Hartford, CT is seeking a Clinical Claim Review Nurse (RN) to evaluate clinical information and documentation, applying criteria and policies in line with regulatory requirements and plan benefits.

You will review records, coordinate with clinicians, support claims processing, train staff, and identify trends. An active RN license with 2–3 years of experience and strong analytical skills are required.

Qualifications

• Nursing degree (RN) is required.
• Minimum 2–3 years of professional RN experience.
• Strong analytical skills to assess medical claims.

Responsibilities

• Review and interpret clinical documentation from medical records.
• Apply clinical decision-making to post-service claims using appropriate criteria.
• Coordinate clinical resolutions independently with clinician/MD support.
• Act as a resource for customer service and claims processing teams.
• Train new staff and provide cross-training to team members.
• Identify trends and flag discrepancies or potential fraud.
• Remain compliant with applicable laws and internal workflows.

Skills

RN license

Analytical skills

Claims processing experience

Education

Associates Degree in Nursing

Bachelor of Science in Nursing

Tools

Microsoft Suite

Job description

CVS Health Hartford, CT is seeking a Clinical Claim Review Nurse (RN) to evaluate clinical information and documentation, applying criteria and policies in line with regulatory requirements and plan benefits.

You will review records, coordinate with clinicians, support claims processing, train staff, and identify trends. An active RN license with 2–3 years of experience and strong analytical skills are required.