RN Clinical Claims Reviewer — Precision in Patient Claims

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement options

Job summary

CVS Health in Jackson, MS is seeking a Clinical Claim Review Nurse to evaluate post-service claims by reviewing medical records and applying clinical criteria consistent with state and federal regulations. The role requires RN licensure and 2–3 years of clinical experience.

Responsibilities include coordinating with clinicians, supporting claims teams, training staff, and monitoring for discrepancies. Competitive benefits and full-time hours are offered.

Qualifications

• RN licensure and nursing degree required.
• 2–3 years of professional RN experience or equivalent clinical experience.
• Strong analytical skills to assess medical claims.

Responsibilities

• Review and interpret clinical documentation for post-service claims.
• Apply clinical criteria and policies in line with regulatory requirements.
• Coordinate clinical resolutions with clinician/MD support as needed.
• Serve as a resource for customer service and claims teams.
• Identify trends and report discrepancies or potential fraud.

Skills

Analytical skills

Attention to detail

Education

Nursing degree (RN)

Associate degree in Nursing

Bachelor of Science in Nursing

Tools

Microsoft Office

Utilization Management experience

Job description

CVS Health in Jackson, MS is seeking a Clinical Claim Review Nurse to evaluate post-service claims by reviewing medical records and applying clinical criteria consistent with state and federal regulations. The role requires RN licensure and 2–3 years of clinical experience.

Responsibilities include coordinating with clinicians, supporting claims teams, training staff, and monitoring for discrepancies. Competitive benefits and full-time hours are offered.