RN Clinical Claims Reviewer - Drive Accurate Post-Service Decisions

CVS Health; Lexington (KY); On-site; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Clinical Claim Review Nurse to assess and interpret clinical documentation for post-service claims. You will apply clinical criteria, coordinate resolutions with clinicians, and support claims processing teams while staying compliant with laws and policies.

The role emphasizes confidentiality, accuracy, and ongoing learning in a fast-paced environment. The ideal candidate holds an RN license with 2-3 years of experience, strong analytical skills, and familiarity with

Job description

CVS Health is seeking a Clinical Claim Review Nurse to assess and interpret clinical documentation for post-service claims. You will apply clinical criteria, coordinate resolutions with clinicians, and support claims processing teams while staying compliant with laws and policies.

The role emphasizes confidentiality, accuracy, and ongoing learning in a fast-paced environment. The ideal candidate holds an RN license with 2-3 years of experience, strong analytical skills, and familiarity with