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Insurance Claims Nurse Jobs (NOW HIRING)

CNA Insurance

NY · On-site

CNA is one of the premier providers of professional liability insurance. CNA offers excellent work/life balance opportunities and a strong benefits package. We are currently seeking a Complex Claims ...

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Insurance Claims Nurse information

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$12

$23

$43

How much do insurance claims nurse jobs pay per hour?

As of Sep 14, 2026, the average hourly pay for insurance claims 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 claims nurse do?

An Insurance Claims Nurse, also known as a nurse case manager or nurse reviewer, evaluates medical claims submitted to insurance companies. They review medical records to ensure that treatments and procedures are medically necessary and covered under the patient's insurance policy. These nurses use their clinical expertise to interpret medical information, communicate with healthcare providers, and help determine the appropriate level of care or coverage. Their work helps prevent fraud and ensures that claims are processed accurately and efficiently.

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

To thrive as an Insurance Claims Nurse, you need a valid nursing license, clinical experience, and a solid understanding of medical terminology and insurance processes. Familiarity with claims management software, electronic health records (EHRs), and sometimes certification in case management (such as CCM) are typically required. Strong analytical thinking, attention to detail, and effective communication skills help you accurately evaluate claims and collaborate with patients, providers, and insurers. These competencies are essential to ensure fair, timely claims resolution and maintain compliance with healthcare and insurance regulations.

How does an insurance claims nurse typically collaborate with other professionals during the claims review process?

Insurance Claims Nurses work closely with claims adjusters, physicians, and case managers to evaluate the medical aspects of insurance claims. They review medical records, assess treatment plans, and provide expert opinions on the necessity and appropriateness of care. Effective communication and teamwork are essential, as their input helps determine coverage decisions and ensures that claims are processed efficiently and fairly. This collaborative environment allows for shared expertise and often presents opportunities to learn from other professionals in the insurance and healthcare fields.

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

AspectInsurance Claims NurseInsurance Adjuster
Required CredentialsRN license, possibly certifications in case management or insuranceState licensing, insurance certifications (e.g., AIC, CPCU)
Work EnvironmentHospitals, clinics, insurance companies, telehealthInsurance companies, claims offices, field work
Employer & Industry UsageHealthcare and insurance sectorsInsurance industry, claims processing
Common Search & Comparison IntentUnderstanding healthcare-related claims and patient careEvaluating claims, assessing damages, settling insurance claims

Insurance Claims Nurses focus on healthcare-related claims, utilizing nursing skills to evaluate patient needs, while Insurance Adjusters assess damages and process claims for insurance companies. Both roles require industry-specific certifications and work within the insurance sector, but their daily tasks and environments differ significantly.

Do insurance companies hire insurance claims nurses?

Insurance claims nurses are employed by insurance companies to review and assess medical claims, verify coverage, and ensure proper documentation. They often work in claims departments, utilizing clinical knowledge and claims processing systems to evaluate the validity of claims and support the claims adjustment process.
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What cities are hiring for Insurance Claims Nurse jobs?

Cities with the most Insurance Claims Nurse job openings:

What are the most commonly searched types of Insurance Claims Nurse jobs?

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What states have the most Insurance Claims Nurse jobs?

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

What are popular job titles related to Insurance Claims Nurse jobs?

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

Insurance Claims Nurse jobs near you
Infographic showing various Insurance Claims Nurse job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 76% Full Time, 18% Part Time, and 5% Contract. Highlights an 84% Physical, 1% Hybrid, and 15% Remote job distribution, with an average salary of $48,885 per year, or $23.5 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 11 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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