Clinical Claims Review Nurse

CVS Health Careers

. Review and interpret clinical documentation from medical records or systems .

Posted 11/11/2026full-timeRemote • North Dakota • United StatesJuniorMid-Level💰 $26 - $69 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical documentation review and interpretation, applying clinical decision-making for post-service claims while ensuring compliance with organizational and state-specific regulations. Proficient in utilizing technology for communication and troubleshooting, with a strong focus on analytical skills and training capabilities.

Highest-signal resume keywords

Registered Nurse (RN)Clinical Documentation ReviewAnalytical SkillsMicrosoft Office 365EHR Portals

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Decision-MakingClaims ProcessingTrend IdentificationTechnical TroubleshootingCompliance with HIPAAInternet Speed RequirementsMultiple Monitor NavigationClinical Criteria ApplicationFeedback ProvisionTraining and Cross-Training

Soft Skills

Communication SkillsCustomer Service OrientationOpenness to Learning

Tools & Technologies

VPNEHR PortalsMicrosoft Office 365Google WorkspaceTeams Messaging

Certifications & Qualifications

Nursing Degree (RN)

Industry Keywords

Clinical ResolutionsFraudulent ActivitiesOrganizational ComplianceState-Specific RequirementsMedical Claims Assessment

About the role

Key responsibilities & impact

Review and interpret clinical documentation from medical records or systems
Apply clinical decision-making and appropriate clinical criteria and policies for post-service claims
Coordinate clinical resolutions independently, with clinician/MD support as required
Serve as a resource for customer service and claims processing teams
Train new staff and cross-train existing team members
Identify trends and provide feedback to leadership about discrepancies or potential fraudulent activities
Stay current with applicable laws, regulations, and internal workflows to ensure compliance with organizational and state-specific requirements

Requirements

What you’ll need

Nursing degree (RN)
Minimum of 2–3 years of professional experience as a licensed Registered Nurse (RN), or equivalent clinical experience
Strong analytical skills to assess medical claims
Direct/hardwired internet connection to a modem/router within 7 feet of the computer
Minimum internet speed of 50 Mbps download and 5 Mbps upload
Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently living
Ability to use multiple monitors and navigate multiple applications
Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace applications
Ability to access secure systems such as VPN and EHR portals
Ability to follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links
Ability to troubleshoot common technical issues independently
Openness to learning new skills as the workplace evolves

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
Company-provided equipment (keyboard, monitor, computer, headset, etc.)
CVS Health bonus, commission or short-term incentive program eligibility