RN Clinical Claims Reviewer — Impactful Quality

CVS Health; Idaho Falls (ID); On-site; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health in the United States is seeking a Clinical Claim Review Nurse to evaluate clinical information and determine payment eligibility for member and provider claims, following regulatory and plan requirements.

You will review medical records, apply clinical criteria, coordinate resolutions with clinicians, and support customer service and claims teams. This position is 40 hours weekly and full-time.

Qualifications

• RN licensed with 2–3 years of professional experience.
• Associates Degree in Nursing required; BSN preferred.
• Strong analytical skills to assess medical claims.

Responsibilities

• Review clinical documentation and apply policies for post-service claims.
• Coordinate clinical resolutions with clinicians as needed.
• Assist customer service and claims processing teams.
• Identify trends and report discrepancies.

Skills

RN

Analytical skills

Clinical claims analysis

Education

Associates Degree in Nursing

Bachelor of Science in Nursing preferred

Tools

Microsoft Suite

Job description

CVS Health in the United States is seeking a Clinical Claim Review Nurse to evaluate clinical information and determine payment eligibility for member and provider claims, following regulatory and plan requirements.

You will review medical records, apply clinical criteria, coordinate resolutions with clinicians, and support customer service and claims teams. This position is 40 hours weekly and full-time.