Medical Claims Reviewer Jobs - (At Remote RN)

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.

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