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Insurance Claim Review Nurse Jobs (NOW HIRING)

Cobalt Benefits Group

Utilization Review Nurse

... insurance options to our clients and members. The UR Nurse is responsible for reviewing clinical ... claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA ...

ePATHUSA Inc

Medical Review Nurse

VA · Remote

$76K - $97K/yr

Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews ... A minimum of three years of lead/supervisory experience in the health insurance industry, a ...

UMR

SSBV Clinical Claim Review | , |

$28.94 - $51.83/hr

Ssbv Clinical Claims Review Rn Optum is a global organization that delivers care, aided by ... Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability ...

TPIS

Clinical Review Nurse

San Juan, PR · On-site

$250/hr

Monday to Friday between 8:00am - 7:00pm This role investigates Health Insurance Waste and Error ... claim for further review in a production environment. You'll be rewarded and recognized for your ...

New

divvyDOSE

SSBV Clinical Claim Review | , |

$28.94 - $51.83/hr

Ssbv Clinical Claims Review Rn Optum is a global organization that delivers care, aided by ... Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability ...

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... Insurance • 401k/403B with Employer Match • Tuition Assistance - 5,250/year and discounted ...

Sentara Health Plans

$60 - $80/hr

The Utilization Review Nurse is responsible for utilization management services within the scope of ... Pet Insurance * Legal Resources Plan Colleagues have the opportunity to earn an annual ...

Ova Technologies

Utilization Review Nurse

Alpharetta, GA · On-site

Utilization Review Nurse Location: [City, State / Remote] Employment Type: Full-Time Experience: 2 ... Communicate with insurance companies, managed care organizations, and third-party payers regarding ...

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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.

Pre-Claim Review Coordinator - ProHealth Home Health and Hospice (Dallas, TX)

Addison, TX • On-site

ProHealth Home Health & Hospice
Fitness and Sports Centers • 201 - 500 employees
Learn more about ProHealth Home Health & Hospiceexternal

Full-time

Re-posted 18 days ago

Job description

JOB SUMMARY:

A licensed practical/vocational nurse who supports the region with organizing, reviewing, and submitting records for pre-claim review (PCR) for Review Choice Demonstration (RCD) to ensure affirmation. The Pre-Claim Review Coordinator will review all Medicare episodes in assigned RCD state(s) to ensure compliance with regulations and verify necessary components are in place for affirmation and billing.

QUALIFICATIONS:

1. Graduate of a state approved school of practical (vocational) nursing and current state license, or a multi-state license issued by a Nurse Licensure Compact (NLC) member state.

2. Two to four years home health experience preferred.

3. Knowledge of home health regulations required

4. Knowledge of Pre-Claim Review and Review Choice Demonstration preferred

5. Able to read, write and comprehend English.

6. Organized with a strong attention to detail.

7. Strong computer skills, HCHB experience is a plus.

RESPONSIBILITIES:

1. Understands and adheres to established Agency policies and procedures.

2. Works closely with Central Intake Department, Intake Manager, and/or Director of Intake, Billing Department, and Regional Director of Operations.

3. Understanding of home health practices and terminology.

4. Organizes, reviews, and processes pre-claim review workflow to ensure compliance with regulatory requirements and achieve claim affirmation for Medicare billing.

5. Reviews each Medicare patient episode to verify that all necessary components are present and coordinates with team members to resolve concerns that would lead to non-affirmation, claim rejection, or claim ADR.

6. Organizes submission packets and uploads to government processing provider and tracks status of submissions, affirmations, denials, non-affirmations, etc.

7. Responsible for entering tracking number (UTN) into electronic medical record and attaching affirmation letter to client’s medical record.

8. Serves as a role model for other colleagues by setting an example of high standards in dress, conduct, cooperation, and job performance.

9. Observes confidentiality and safeguards all patient related information.

10. Accepts responsibility for regular attendance and punctuality; fulfills job-related requirements without regard to time involved.

11. Develops a cooperative relationship and communicates effectively with all employees.

12. Reports problems and concerns to Supervisor.

13. Other duties as assigned by the Regional Director of Operations.

WORKING ENVIRONMENT:

Works indoors in Agency office/office space

JOB RELATIONSHIPS:

Supervised by: Regional Director of Operations

RISK EXPOSURE:

Low Risk

LIFTING REQUIREMENTS:

Ability to perform the following tasks if necessary:

· Ability to participate in physical activity

· Ability to work for extended periods of time while sitting, standing and/or being involved in physical activity.

· Moderate lifting.

· Ability to do moderate bending, lifting, and standing on a regular basis.

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