RN Clinical Claims Reviewer — Impactful Post‑Service Reviews

CVS Health; Manchester (NH); 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 seeking a Clinical Claim Review Nurse in Manchester, NH. You will review clinical documentation, apply appropriate criteria to post-service claims, and coordinate resolutions with clinicians as needed.

The role requires RN licensure and 2–3 years of experience, with strong analytical skills and MS Office proficiency. This full-time position offers a comprehensive benefits package and opportunities for professional growth.

Qualifications

• RN with 2–3 years of professional experience as a licensed RN or equivalent clinical experience.
• Strong analytical skills to assess medical claims.
• Clinical decision making experience helpful.

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.
• 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.
• Ensure compliance with laws, regulations, and internal workflows.

Skills

Analytical skills

Clinical judgment

Team coordination

Education

Associates Degree in Nursing

Bachelor of Science in Nursing

Tools

Microsoft Suite

Job description

CVS Health is seeking a Clinical Claim Review Nurse in Manchester, NH. You will review clinical documentation, apply appropriate criteria to post-service claims, and coordinate resolutions with clinicians as needed.

The role requires RN licensure and 2–3 years of experience, with strong analytical skills and MS Office proficiency. This full-time position offers a comprehensive benefits package and opportunities for professional growth.