Medical Claims Reviewer Jobs - (At Remote RN) – Indeed Jobs US

CVS Health is currently hiring Remote Registered Nurses (RNs) for Medical Claims Reviewer roles. This position is designed for experienced RNs who want to move into the non-clinical side of healthcare while still making a significant impact. You'll be responsible for reviewing, assessing, and processing medical claims in alignment with clinical guidelines, coverage policies, and regulatory compliance standards—all from a remote work environment.

This is a perfect opportunity for RNs seeking a shift away from direct patient care into healthcare administration, insurance processing, or quality review.

Job Overview

• Job Title: Medical Claims Reviewer (Remote RN)

• Company: CVS Health

• Location: Remote (United States only)

• Employment Type: Full-Time

• Salary Range: $75,000 – $95,000 per year

Key Responsibilities

• Review incoming medical claims and supporting documentation

• Evaluate clinical appropriateness and coverage eligibility

• Identify coding errors or discrepancies

• Collaborate with providers or internal departments on claims clarification

• Ensure compliance with state and federal regulations, including HIPAA

Qualifications

• Active RN license (U.S.)

• 3+ years of clinical nursing experience

• Prior experience in claims review, case management, or utilization review

• Strong understanding of ICD-10, CPT codes, and payer systems

• Detail-oriented with excellent analytical skills

• Proficient with healthcare software and EHR systems

• Ability to work independently in a secure, remote environment

Benefits

• Competitive annual salary

• Remote-first position with flexible schedule

• Full healthcare and dental benefits

• Paid time off, holidays, and 401(k)

• Opportunities for advancement into compliance or clinical review leadership

How to Apply

Interested candidates should apply through the CVS Health careers portal, submitting a current resume, RN license, and any certifications in claims or utilization review. Interviews are held virtually. Multiple remote roles are open across the U.S.