98 claims nurse jobs at 60 companies in United States
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Complex Clinical Claims Analyst
United States
$100k-$110k/yr RemoteFull Time
3+ YOENursing credential (BSN or RN/LPN/LVN) or equivalent experience, 2+ years complex claims review, 3+ years billing/coding, strong research and analysis, Microsoft Office/Teams proficiency.
Microsoft Excel, Microsoft PowerPoint, Microsoft Word, Microsoft Teams, Microsoft Office
2d
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Complex Claims Specialist - AMAP
Plano or Kansas City
OnsiteFull Time
5+ YOERN licensure or bachelor's in healthcare management or related field, 5+ years of clinical or risk management experience, health insurance knowledge, analytical skills, and Microsoft product proficiency.
Microsoft Word, Microsoft Outlook, Microsoft PowerPoint
1w
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Claims Representative, Auto | PIP
Ohio or Florida or New Jersey
$60k-$65k/yr RemoteFull Time
3+ YOEState adjuster license required, 3+ years PIP/medical payment/workers' comp or equivalent, bachelor’s preferred, BLS/nursing experience a plus, medical terminology knowledge, Microsoft Office proficiency.
Microsoft Office
2w
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Nurse Reviewer - Medicaid
United States
$66k-$106k/yr RemoteFull Time
3+ YOEActive nursing or physical therapy license, 3+ years clinical or claims review experience, bachelor’s/master’s/associate with corresponding experience, strong investigative and communication skills, U.S. citizenship required.
1d
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Litigation and Claims Specialist
Rochester, New York, United States
$70k-$90k/yr OnsiteFull Time
3+ YOERequires 3 years of experience in healthcare, risk management, nursing, human resources, or legal work, or a bachelor's degree. HRM or CPHRM certification required within 24 months of hire.
1mo
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Occupational Health Nurse
Shepherdsville, Kentucky, United States
OnsiteFull Time
2+ YOEBachelor of Science in Nursing, 2 years workers' compensation experience, manage WC claims, ergonomic assessments, FMLA support, flexible schedule for nights/weekends, strong communication skills.
3w
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Nurse Disability Consultant
Omaha or United States
$73k-$132k/yr RemoteFull Time
4+ YOEActive RN license, bachelor\u0002s degree or 4 years nursing experience, ability to evaluate medical information, strong written and verbal communication, clinical judgment for disability claims.
3d
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Medical Review Nurse- Medicare
United States
$66k-$106k/yr RemoteFull Time
3+ YOERequires an active US nursing license, medical or claims review experience, and 3–7 years based on degree. Strong investigative, communication, organization, and PC skills; US citizenship required.
2w
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Stop Loss Nurse
United States
$80k-$85k/yr RemoteFull Time
2+ YOERequires nursing degree and active RN license, 2+ years clinical experience, 2+ years case management/utilization review experience, strong clinical assessment and claims knowledge, and ability to obtain CCM within 3 years.
2mo
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Clinical Nurse Risk Manager
Savannah, Georgia, United States
$38-$59/hr OnsiteFull Time
3+ YOEBachelors in nursing required, 3+ years nursing experience, professional state license required; risk management experience and masters preferred, ability to investigate claims, prepare clinical reviews, assist defense counsel, and provide clinical education.
2w
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Nurse Reviewer, RN
Cheyenne, Wyoming, United States
HybridFull Time
Active unrestricted Wyoming RN license required; review claims and appeals, apply medical policy using Interqual, collaborate with providers and pharmacists, and exercise critical thinking.
Interqual
4d
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Medical Review Specialist III (DRG Claims)
United States
RemoteFull Time
4+ YOERequires a nursing degree or diploma, four years of claims knowledge, four years of medical-surgical RN experience, four years of insurance policy application experience, RN licensure, and a valid driver's license.
Microsoft Office, Internet, Intranet, ICD-10-CM, PCS, CPT-4
1d
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Nurse Specialist II
United States
$58k-$86k/yr RemoteFull Time
2+ YOEBachelor's degree and 2–4 years of experience required, including medical claims review. Active unrestricted RN licensure required; Medicare/Medicaid knowledge preferred and coding certification preferred.
case management systems
3w
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Medical Review Nurse (RN) - UM/Appeals experience
Florida or Long Beach
OnsiteFull Time
2+ YOEActive unrestricted RN license, 2+ years clinical nursing with ≥1 year utilization review or claims review, knowledge of ICD-10/CPT/HCPC, regulatory requirements, and strong analytic and communication skills.
ICD-10, CPT, HCPC, MCG/InterQual, Microsoft Office
1mo
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Occupational Health Nurse (69795)
Charlotte or North America
$95k-$120k/yr FieldFull Time
Clinical background (RN, paramedic, or similar) with experience in occupational health, workers' compensation, claims management, strong communication, discretion, and ability to travel to field locations.
1w
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Nurse Case Manager II
Hinds County, Mississippi, United States
$56k-$86k/yr OnsiteFull Time, Temporary
5+ YOERequires Mississippi RN licensure and typically 5+ years of experience. Requires Medicaid, EPSDT, FPW, audit, claims, analytical, organizational, communication, Microsoft Office, and document management skills.
Microsoft Office, electronic document management systems
3w
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Utilization Review Nurse LVN
Ontario, California, United States
$72k-$100k/yr OnsiteFull Time
2+ YOEActive CA LVN license, 2+ years acute hospital case management, utilization management experience, knowledge of claims, coding and billing, high school diploma/GED, strong interpersonal skills.
3w
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Payment Integrity Nurse I
Salt Lake City or Medford or Beaverton or Coeur d'Alene or Lewiston or Boise or Burlington or Bend or North Dakota or Fargo or Vancouver or Portland or Renton or Utah or Yakima or Tacoma or Bellevue or Oregon or Spokane or Washington or Idaho or Pocatello or Salem
$77k-$104k/yr RemoteFull Time
3+ YOEAssociate or Bachelor's in health; minimum 3 years clinical or claims experience; unrestricted licensure in OR, WA, ID, or UT (or RN); competency with clinical review, coding, and reimbursement policies; Microsoft Office skills.
Microsoft Word, Microsoft Excel, Microsoft PowerPoint
2mo
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Clinical Healthcare Fraud Investigator - Nurse Auditor
Dallas, Texas, United States
OnsiteFull Time
3+ YOEActive RN license, coding/auditing certification (CPC/CPMA/CFE or equivalent), 3+ years clinical experience, medical record auditing and claims review experience, knowledge of CPT/HCPCS/ICD-10 and CMS/payer rules, Microsoft Office proficiency, strong analytical and communication skills.
Microsoft Office, CPT, HCPCS, ICD-10-CM/PCS
1w
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Medical Review Nurse (AIMRR) 2
Clive, Iowa, United States
$77k-$97k/yr RemoteFull Time
5+ YOECurrent unobstructed US RN license, 5+ years clinical experience, 3+ years medical/claims review, coding knowledge (ICD/CPT/HCPCS), coding certification preferred, BSN preferred, experience with MACs/SMRC/CERT/QIC/BFCC-QIOs.
InterQual, Milliman
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