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Insurance Claim Review Nurse Jobs (NOW HIRING)

UnitedHealthcare

Clinical Claim Review | , |

Review medical and administrative records for audit/compliance review * Travel to provider sites up ... Nurse licensure (RN or LPN) with a current, active, and unrestricted license in Massachusetts * 2+ ...

divvyDOSE

Clinical Claim Review | , |

Review medical and administrative records for audit/compliance review * Travel to provider sites up ... Nurse licensure (RN or LPN) with a current, active, and unrestricted license in Massachusetts * 2+ ...

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · On-site

The Clinical Claim Review RN will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive ...

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · Remote

The Clinical Claim Review RN will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive ...

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · Remote

The Clinical Claim Review RN will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive ...

Selene Holdings

Insurance Claims Specialist

Dallas, TX · On-site

... insurance brokerage, and a real estate owned company. We have office locations in Dallas, TX, ... Prepare management reports summarizing claim review outcomes, payment accuracy, and performance ...

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

Document findings for each claim in a clear and concise manner. * Compile a report explaining the claim reviews, including identified patterns, inappropriate determinations, as well as ...

Addison Group

Forensic Medical Coder

Niagara Falls, NY · Remote

$25 - $30/hr

This position supports insurance-related claim reviews through detailed analysis of medical records ... Nursing background (RN) is a plus but not required. * Experience reviewing Workers' Compensation ...

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Insurance Claim Review Nurse information

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How much do insurance claim review nurse jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for insurance claim review nurse in the United States is $23.50, according to ZipRecruiter salary data. Most workers in this role earn between $17.55 and $25.72 per hour, depending on experience, location, and employer.

What does an insurance claim review nurse do?

An Insurance Claim Review Nurse is a registered nurse who evaluates medical claims submitted to insurance companies. They review patient records, treatment plans, and billing codes to ensure that the services provided are medically necessary and covered under the patient’s insurance policy. Their role helps prevent fraud, control costs, and ensure that claims are processed accurately and efficiently. They may also communicate with healthcare providers and policyholders to gather additional information or clarify details about the claims.

What skills and qualifications are needed to be an insurance claim review nurse?

To thrive as an Insurance Claim Review Nurse, you need clinical expertise, a nursing degree with active RN licensure, and experience in utilization review or case management. Familiarity with claims processing systems, ICD-10/CPT coding, and health insurance regulations is essential, and certification such as CCM or URAC accreditation can be advantageous. Analytical thinking, attention to detail, and effective written communication are crucial soft skills for reviewing claims and collaborating with providers. These skills ensure accurate, efficient claim assessments and support compliance with industry standards, reducing errors and unnecessary costs.

What challenges does an insurance claim review nurse face when evaluating claims?

Insurance Claim Review Nurses often encounter complex cases requiring careful assessment of medical records, treatment plans, and insurance policies. A common challenge is ensuring compliance with both regulatory standards and the insurer’s guidelines while maintaining timely turnaround on reviews. Balancing thoroughness with productivity can be demanding, especially when navigating ambiguous documentation or conflicting medical opinions. Effective communication with physicians, claims adjusters, and policyholders is essential to resolve discrepancies and ensure fair claim outcomes.

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

AspectInsurance Claim Review NurseInsurance Claims Adjuster
Required CredentialsRN license, possibly certifications in case management or reviewAdjuster license, certifications like AIC or CPCU
Work EnvironmentHealthcare settings, insurance companies, remote reviewField or office-based, investigating and settling claims
Industry UsageHealth insurance, workers' compensationProperty, casualty, health insurance

Both roles involve evaluating insurance claims, but the Insurance Claim Review Nurse focuses on health-related claims with medical expertise, while the Insurance Claims Adjuster handles a broader range of insurance types, often involving investigation and settlement processes.

What are popular job titles related to Insurance Claim Review Nurse jobs?

For Insurance Claim Review Nurse jobs, the most frequently searched job titles are:

Infographic showing various Insurance Claim Review Nurse job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 73% Full Time, 21% Part Time, and 5% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $48,885 per year, or $23.5 per hour.

Insurance Claim Coordinator (FT)

Whiteville, NC • On-site

Columbus Regional Healthcare System
See more jobs at Columbus Regional Healthcare Systemexternal

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Retirement

Re-posted 12 days ago

Job description

Job Opportunity At Columbus Regional Healthcare System

At Columbus Regional Healthcare System we offer professional growth and advancement for every employee. Working at CRHS allows you to have the intimate hospital feel while still being provided with the large healthcare system resources.

Job Description

Reviews unpaid third party payer claims and determines the reason why the claim is unpaid and arranges with the payer for the payment of the claim. Processes all correspondence and request for additional information from third party payers. Reviews all Explanation of Benefits (EOB's) to insure the hospital is paid appropriately. Provides guidance, direction, and training in claim payment techniques to other Patient Accounting employees.

Qualifications
  • High school graduate.
  • Proficient in use of basic office machines and computer applications.
  • Knowledge of third party insurance payer requirements including billing and follow up techniques, electronic claims processing, and government regulations.
  • Knowledge of medical terminology, medical record coding, and patient registration techniques.

Preferred: Associates degree in Business Administration.

Experience: A minimum of six months related experience in insurance claim processing and insurance claim follow up. Given training and on-the-job experience, incumbent should be proficient in the basic aspects of the job within three months

Perks + Benefits
  • CRHS Campus Gym (open 7 days a week)
  • Competitive Pay Rates
  • CRHS Campus Cafeteria
  • Company Swag
  • Comprehensive Benefit Package
  • Tuition Reimbursement
  • Matching Retirement Plan
  • Sign on Bonus (select positions)

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