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Claims Review Nurse Jobs (NOW HIRING)

Machinify

Medical Review Nurse II - SNF/MDS Auditor

$85K - $100K/yr

Auditing claims for medically appropriate services provided in skilled nursing facility settings while applying appropriate medical review guidelines, policies and rules. * Document all findings ...

Machinify

Medical Review Nurse II - SNF/MDS Auditor

$85K - $100K/yr

Auditing claims for medically appropriate services provided in skilled nursing facility settings while applying appropriate medical review guidelines, policies and rules. * Document all findings ...

Empower AI

Medical Reviewer III (Medicare/DRG)

$28.38/hr

... Review Lead Specialist Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate's degree - OR - Diploma in Nursing. At least four (4) years claims knowledge ...

Empower AI

Medical Reviewer III (Medicare/DME)

$28.38/hr

... Review Lead Specialist Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate's degree - OR - Diploma in Nursing. At least four (4) years claims knowledge ...

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Claims Review Nurse information

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$30.5K

$64.6K

$90K

How much do claims review nurse jobs pay per year?

As of Aug 21, 2026, the average yearly pay for claims review nurse in the United States is $64,609.00, according to ZipRecruiter salary data. Most workers in this role earn between $51,000.00 and $75,500.00 per year, depending on experience, location, and employer.

What is a claims review nurse?

Claims Review Nurses are registered nurses who evaluate medical claims submitted to insurance companies to ensure accuracy, necessity, and compliance with policy guidelines. They review patient records and treatment plans to determine if the services provided are covered and medically necessary. Their work helps prevent fraudulent claims and ensures that patients receive appropriate care while keeping healthcare costs in check. Claims Review Nurses often work for insurance companies, government agencies, or healthcare organizations.

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

To thrive as a Claims Review Nurse, you need strong clinical expertise, a valid RN license, and a solid understanding of medical terminology and insurance guidelines. Familiarity with claims management software, electronic health records, and utilization review systems is typically required. Attention to detail, critical thinking, and effective communication are standout soft skills for this role. These skills ensure accurate claims assessment, compliance with regulations, and effective collaboration with both clinical and insurance teams.

What are some common challenges faced by claims review nurses in balancing clinical accuracy with administrative requirements?

Claims Review Nurses often encounter the challenge of ensuring that clinical judgments align with insurance policies and regulatory guidelines. This means carefully reviewing medical records for accuracy while also navigating complex administrative procedures and documentation requirements. Balancing the need for thoroughness with the pressure of meeting productivity targets can be demanding, but strong organizational skills and attention to detail are key to success. Collaboration with other healthcare professionals and claims adjusters is frequent, requiring clear communication to resolve discrepancies or obtain additional information.

What is the difference between Claims Review Nurse vs Claims Adjuster?

AspectClaims Review NurseClaims Adjuster
Required CredentialsRN license, certifications in case management or reviewAdjuster license, relevant insurance certifications
Work EnvironmentHealthcare settings, insurance companies, third-party review firmsInsurance companies, third-party claims organizations
Industry UsageHealthcare insurance, medical reviewProperty, casualty, health insurance claims

Claims Review Nurses focus on evaluating medical claims based on healthcare standards, requiring nursing credentials. Claims Adjusters handle a broader range of insurance claims, including property and casualty, often with different licensing. Both roles work within insurance companies or third-party organizations but serve distinct functions in claims processing.

More about Claims Review Nurse jobs

What cities are hiring for Claims Review Nurse jobs?

Cities with the most Claims Review Nurse job openings:

What states have the most Claims Review Nurse jobs?

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

What job categories do people searching Claims Review Nurse jobs look for?

The top searched job categories for Claims Review Nurse jobs are:

Claims Review Nurse jobs near you
Infographic showing various Claims Review Nurse job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 79% In-person, and 21% Remote job distribution, with an average salary of $64,609 per year, or $31.1 per hour.

Claims Review Nurse (CERT)

Catapult Consultants, LLC

Arlington, VA • On-site

Full-time

Re-posted 21 days ago

Job description

Company Description
Catapult Consultants is a global, professional services and management consulting company specializing in business, analytical and information systems solutions. We support mission-critical programs in the Intelligence Community and Defense and Civilian sectors. Our health care soultions division is currently looking for Registered Nurse to support our transplant program quality assessment and performance improvement program. For more information about us go to www.catapultconsultants.com.
Job Description
This position provides support for a federal government project to review Medicare documentation as part of the Centers for Medicare & Medicaid Services' (CMS) Comprehensive Error Rate Testing (CERT) program to measure improper payments in the Medicare fee-for-service (FFS) program.
  • Full-Time, Monday - Friday
  • Two open positions located in Richmond, Virginia

Responsibilities:
  • Review claim documentation and associated medical records related to the CMS CERT program and determine whether Medicare FFS program services qualify for coverage and payment.
  • Assess whether claim documentation and associated medical records complies with Medicare coverage, coding and billing rules.
  • Compare documentation assessments to those of the Medicare contractor who originally reviewed and paid the claims and note which claims are in "error" if they have been incorrectly billed, paid or processed the services.
  • Other duties as assigned

Qualifications
  • Registered Nurse (RN) with an active license
  • Associate's, Diploma or Bachelor's degree in Nursing
  • 5 years of full-time work experience
  • 3 to 5 years of experience in coding
  • At least 2 years of experience in inpatient, acute care coding for Medicare reimbursement and MS-DRG experience
  • Knowledge of standard coding conventions, such as DRGs, ICD-9-CM, HCPS and CPT
  • Knowledge of Payment methodologies and Medicare guidelines
  • Familiarity and understanding of Medicare rules, regulations, policies and procedures
  • Familiar with Microsoft Word, Excel and Outlook
  • Highly-motivated, detail-oriented, quick learner with a professional demeanor
  • Ability to effectively work independently

Additional Information
Catapult Consultants does not discriminate in practices or employment opportunities on the basis of an individual's race, color, national or ethnic origin, religion, age, sex, gender, sexual orientation, marital status, veteran status, disability, or any other proscribed category set forth in federal or state regulations.

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