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Insurance Claims Nurse Jobs (NOW HIRING)

New Mexico Mutual

Claims Specialist

Albuquerque, NM · On-site

... insurance claims under applicable law, corporate policy and best practice. Quality claim handling ... management strategies with nurse case managers and all other expert assignments. * Upon ...

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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 Jun 17, 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.

Do insurance companies hire nurses?

Yes, insurance companies hire nurses for roles such as claims review, case management, and medical underwriting. These positions often require clinical knowledge, strong communication skills, and sometimes certification or licensure in nursing.

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.

How much do insurance nurses make?

Insurance claims nurses typically earn between $60,000 and $80,000 annually, depending on experience, location, and certifications. They review and process insurance claims, often working in healthcare or insurance companies, and may require knowledge of medical coding and insurance policies.

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.

How to make an extra $1000 a month as a nurse?

Insurance claims nurses can increase their income by taking on additional part-time or freelance work, such as consulting or providing expert reviews for insurance companies. Developing specialized skills in claims processing, certification in insurance or legal nursing, and working flexible hours can help reach extra income goals. Leveraging experience and certifications can also open opportunities for higher-paying roles or side projects.

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.

What are the key skills and qualifications needed to thrive as an Insurance Claims Nurse, and why are they important?

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 to make $150,000 as a nurse?

An insurance claims nurse can reach a $150,000 salary by gaining specialized certifications, such as Certified Claims Professional, and accumulating several years of experience. Working in high-demand areas, taking on leadership roles, or moving into management positions can also increase earning potential, especially with overtime or additional shifts.
More about Insurance Claims Nurse jobs
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? The most popular types of Insurance Claims Nurse jobs are:
What states have the most Insurance Claims Nurse jobs? States with the most job openings for Insurance Claims Nurse jobs include:
What job categories do people searching Insurance Claims Nurse jobs look for? The top searched job categories for Insurance Claims Nurse jobs are:
Insurance Claims Nurse jobs near you
Infographic showing various Insurance Claims Nurse job openings in the United States as of June 2026, with employment types broken down into 6% As Needed, 23% Full Time, 28% Part Time, 41% Contract, and 2% Nights. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $48,885 per year, or $23.5 per hour.

Investigative Clinician - Insurance Claims

CoventBridge Group

Remote

$80K - $110K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

CoventBridge Group rating

6.7

Company rating: 6.7 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

252nd of 428 rated business services

Job description

Overview
Experienced Investigative Clinician - Insurance Claims
Remote
Are you a licensed healthcare professional( RN or NP) with a passion for uncovering the truth behind medical claims? We're seeking an experienced Investigative Clinician to join our team and support a major national client in evaluating the medical validity of insurance claims. This role blends clinical expertise with investigative acumen to detect, prevent, and resolve fraudulent, exaggerated, or non-medically necessary claims.
As an integral member of the Special Investigations Unit (SIU), you'll collaborate closely with adjusters, legal teams, and investigators to analyze medical documentation and uncover inconsistencies or red flags. If you thrive in a fast-paced, analytical environment and want to make a real impact in the fight against insurance fraud, we want to hear from you.
Responsibilities/ Requirements
Key Responsibilities:
  • Conduct thorough reviews of medical records, treatment plans, and billing documentation to assess accuracy, consistency, and medical necessity.
  • Identify patterns of overutilization, upcoding, or potential fraud and abuse.
  • Provide clinical expertise to claims investigators, legal personnel, and other stakeholders in evaluating questionable claims.
  • Interview claimants, healthcare providers, and related parties as needed to clarify details and verify medical facts.
  • Prepare clear, detailed, and objective clinical summary reports with findings and recommendations.
  • Deliver expert clinical opinions regarding treatment appropriateness and outcomes.
  • Remain up-to-date with current clinical practices, fraud trends, billing guidelines, and relevant regulations.
  • Participate in depositions or testify as a clinical expert in support of litigation efforts, when required.

Essentials for this Role:
  • Active U.S. license as a healthcare professional (RN, NP, MD, or equivalent, no LPN's).
  • At least 3-5 years of hands-on clinical experience.
  • Prior work experience in insurance claims review, utilization management, or healthcare fraud investigation highly preferred.
  • Proficient in reviewing electronic health records (EHRs), ICD-10, CPT coding, and medical billing practices.
  • Exceptional critical thinking, detail orientation, and analytical skills.
  • Strong verbal and written communication skills, including report writing.
  • Ability to work independently and manage multiple concurrent assignments in a remote environment

Preferred Qualifications
  • Certification in fraud investigation (e.g., Certified Fraud Examiner - CFE, Accredited Health Care Fraud Investigator - AHFI, or similar).
  • Familiarity with claims management platforms and case tracking systems.
  • Working knowledge of state and federal healthcare laws and insurance regulations.

Benefits
Compensation & Perks That Work For You:
We believe great work deserves great rewards. Here's what you can expect when you join our team:
Benefits:
  • Career development training
  • Medical, Dental, Vision plans
  • Life, LTD and STD paid by the employer
  • 401(k) with company match
  • Paid vacation
  • Paid Paternity/Maternity Leave, after 1 year of service
  • Tuition assistance after 1 year of service

The salary range for this role is between $80,000.00 - $110,000.00 annually. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.
Pursuant to the respective Fair Chance Ordinances of both Los Angeles and San Francisco, we will consider for employment qualified applicants with arrest and conviction records.
CoventBridge Group is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics.
CoventBridge Group is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge Group will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com).
https://coventbridge.com/licensing/

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