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Claims Nurse Jobs (NOW HIRING)

Cna

General Liability Claims Consultant

Atlanta, GA · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Boston, MA · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Lake Mary, FL · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Dewitt, NY · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Tarrytown, NY · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Warren, NJ · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Princeton, NJ · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Littleton, CO · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Radnor, PA · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Los Angeles, CA · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Plano, TX · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Chicago, IL · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Wyomissing, PA · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Melville, NY · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

Cna

General Liability Claims Consultant

Glastonbury, CT · Hybrid

$72K - $141K/yr

At CNA, we strive to create a culture in which people know they matter and are part of something ... Manages highly complex investigations of claims, including coverage issues, liability ...

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All JobsFinance And Insurance JobsInsurance JobsInsurance Claims Specialist JobsClaims Nurse Jobs

Claims Nurse information

See salary details

$35K

$87.9K

$139K

How much do claims nurse jobs pay per year?

As of Sep 15, 2026, the average yearly pay for claims nurse in the United States is $87,861.00, according to ZipRecruiter salary data. Most workers in this role earn between $68,000.00 and $105,000.00 per year, depending on experience, location, and employer.

What is a claims nurse?

Claims Nurses are registered nurses who work with insurance companies, employers, or third-party administrators to evaluate medical claims. They review medical records, assess the necessity and appropriateness of treatments, and help determine the validity of claims related to health, disability, or workers’ compensation cases. Their expertise helps ensure that claims are processed accurately and that claimants receive appropriate care and benefits. Claims Nurses also communicate with healthcare providers, claimants, and insurance adjusters to gather and clarify information. Their role is vital in balancing patient needs with policy guidelines and cost management.

What are the key skills and qualifications needed to thrive as a claims nurse?

To thrive as a Claims Nurse, you need a solid nursing background, an active RN license, and expertise in medical assessment and case review. Familiarity with healthcare claims systems, ICD-10/CPT coding, and utilization review software is commonly required. Strong analytical skills, attention to detail, and effective communication with both medical professionals and insurance representatives are crucial soft skills. These abilities ensure accurate claims evaluations, prevent fraud, and support fair and efficient claims processing.

How does a claims nurse typically collaborate with insurance adjusters and healthcare providers during the claims review process?

Claims Nurses play a vital role in bridging the gap between medical providers and insurance adjusters. They review medical records, assess the necessity and appropriateness of treatments, and provide clinical insights to help adjusters make informed decisions about claim approvals or denials. Effective communication and collaboration are essential, as Claims Nurses often clarify medical terminology, discuss case details, and sometimes participate in case management meetings to ensure accurate, timely claim resolutions. This teamwork helps maintain fairness and efficiency throughout the claims process.

What is the difference between Claims Nurse vs Claims Adjuster?

AspectClaims NurseClaims Adjuster
Required CredentialsRN license, certifications in case management or nursingHigh school diploma or equivalent, licensing varies by state
Work EnvironmentHospitals, clinics, insurance companies, telehealthInsurance companies, third-party administrators, claims offices
Industry UsageHealthcare, insurance

Claims Nurses and Claims Adjusters both work within the insurance industry, but Claims Nurses focus on evaluating medical claims from a healthcare perspective, often requiring nursing credentials. Claims Adjusters handle a broader range of claims, including property and casualty, with less emphasis on medical qualifications. Both roles involve assessing claims, but Claims Nurses bring specialized medical knowledge to the process.

More about Claims Nurse jobs

What cities are hiring for Claims Nurse jobs?

Cities with the most Claims Nurse job openings:

What states have the most Claims Nurse jobs?

States with the most job openings for Claims Nurse jobs include:

What are popular job titles related to Claims Nurse jobs?

For Claims Nurse jobs, the most frequently searched job titles are:

Claims Nurse jobs near you
Infographic showing various Claims Nurse job openings in the United States as of August 2026, with employment types broken down into 4% As Needed, 53% Full Time, 16% Part Time, and 27% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $87,861 per year, or $42.2 per hour.

Medical Review Claims - Nurse Coordinator

Topeka, KS • On-site

Blue Cross and Blue Shield of Kansas
Insurance Services • 1 - 5K employees
Learn more about Blue Cross and Blue Shield of Kansasexternal

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 12 days ago

Job description

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.
Why Join Us?
  • Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
  • Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
  • Professional Growth Opportunities: Advance your career with ongoing training and development programs.
  • Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
  • Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
  • Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks
  • Base compensation is only one component of your competitive Total Rewards package
    • Incentive pay program (EPIP)
    • Health/Vision/Dental insurance
    • 6 weeks paid parental leave for new mothers and fathers
    • Fertility/Adoption assistance
    • 2 weeks paid caregiver leave
    • 401(k) plan matching up to 5%
    • Tuition reimbursement
    • Health & fitness benefits, discounts and resources

Job Summary
The Medical Review Claims Nurse Coordinator directly oversees the day-to-day activities of a team of medical review nurse consultants. Co-responsible, with the other Coordinator and Analyst Supervisor, to research, develop, and implement all training / education materials for the entire Medical Review department. Responsible for ensuring employee production and quality meets department / company goals. Responsible for receiving, researching, answering all direct questions from employees and other departments / divisions regarding employee reviews / decisions. Lead multiple departmental meetings and projects. Participate in divisional meetings along with the Manager.
Work Location
This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.
What you'll do
  • Accountable for performance monitoring, policy enforcement, termination process, disciplinary action, hiring, compliance and team development. Maintaining accurate records of all hiring, firing and disciplinary actions.
  • Ensure supervised employees are compliant with all company, state, and federal regulations.
  • Lead / participate in multiple cross division/department teams.
  • Ensure all supervised employees maintain their clinical licensing and professional coder certifications.
  • Co-responsible for researching, creating, implementing, and maintaining all department processes and education / training material with regular team training sessions.
  • Accountable for identifying and researching production inconsistencies involving policy questions and other problem areas and present solutions to management.
  • Subject matter expert for department, division, and senior management inquiries.
  • Conduct regular audits and assessments of the claim review process to ensure accuracy, regulatory compliance, and identify areas for process improvement.
  • Provide ongoing support and mentorship to staff, fostering professional development and growth.
  • Accountable for independent approval of claims up to $1 million.
  • Must follow URAC standards as required for essential job functions.

Education
  • Bachelor's degree or equivalent in nursing or health related field required

Experience
  • Minimum 6 years' experience in a clinical nursing role (Medical Review Claims experience counts) required
  • Minimum 3 years' experience Medical Review Claims experience preferred
  • Minimum 1 years' experience in a supervisor or leadership role preferred

Licenses and Certifications
  • Current, active, unrestricted Kansas RN License required
  • Certified Coder-AHIMA or AAPC within 3 years of hire required

Travel
  • No travel

Knowledge, Skills and Abilities
  • Must be able to effectively supervise a team with diverse personalities, educational backgrounds, and various management and non-management levels with a wide range of technical / medical understanding.
  • Must be self-directed with the ability to make independent decisions and prioritize personal and employee production activities.
  • Must be able to review and manage sensitive situations related to employees and BCBSKS customers in a positive professional manner.
  • Maintain a working knowledge of medical trends that may affect department production.
  • Must have strong computer skills to operate effectively with company systems and programs.
  • Must be able to maintain a productive and professional relationship with multiple cross departmental and divisional teams.
  • Must be able to communicate technical / medical subjects to employees with sufficient clarity to explain decision outcomes and justify recommendations to team members, senior management, other departments / divisions.
  • Must have a strong analytical background.

Compensation
$85,600 - $107,000 annually
Exempt Grade 16
  • Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Our Commitment to Connection and Belonging
At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.
Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.

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