Our solutions span the insurance senior market sector, focusing on long-term care and Medicare ... We are seeking an experienced Registered Nurse (RN) to serve as a Care Manager supporting Long Term ...
Our solutions span the insurance senior market sector, focusing on long-term care and Medicare ... We are seeking an experienced Registered Nurse (RN) to serve as a Care Manager supporting Long Term ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
At CNA, we strive to create a culture in which people know they matter and are part of something ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
Insurance Claims Nurse information
See salary details
$12.74 - $15.49
8% of jobs
$17.33 is the 25th percentile. Wages below this are outliers.
$15.49 - $18.25
25% of jobs
The median wage is $20.35 / hr.
$18.25 - $21
22% of jobs
$21 - $23.75
15% of jobs
$25.01 is the 75th percentile. Wages above this are outliers.
$23.75 - $26.51
11% of jobs
$26.51 - $29.26
5% of jobs
$29.26 - $32.01
3% of jobs
$32.01 - $34.77
3% of jobs
$34.77 - $37.52
3% of jobs
$37.52 - $40.28
3% of jobs
$40.28 - $43.03
1% of jobs
$12
$23
$43
How much do insurance claims nurse jobs pay per hour?
As of Jun 13, 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?
| Aspect | Insurance Claims Nurse | Insurance Adjuster |
|---|---|---|
| Required Credentials | RN license, possibly certifications in case management or insurance | State licensing, insurance certifications (e.g., AIC, CPCU) |
| Work Environment | Hospitals, clinics, insurance companies, telehealth | Insurance companies, claims offices, field work |
| Employer & Industry Usage | Healthcare and insurance sectors | Insurance industry, claims processing |
| Common Search & Comparison Intent | Understanding healthcare-related claims and patient care | Evaluating 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:
Full-time
Posted 14 days ago
Job description
Who We Are
Wellcove has been recognized as the nation's leading full-service senior market solutions provider for over 25 years. Our solutions span the insurance senior market sector, focusing on long-term care and Medicare Supplement plans. However, we don't stop there. Wellcove also addresses challenges faced in accident & health, disability, and supplemental health insurance programs.
Our team provides individuals and their families with peace of mind knowing their insurance needs will be met in a thoughtful, efficient manner. We are able to do this because of our dedicated associates, innovative solutions, and state-of-the-art technology.
We are seeking an experienced Registered Nurse (RN) to serve as a Care Manager supporting Long Term Care (LTC) insurance claims. This individual contributor role is responsible for conducting comprehensive clinical eligibility reviews to determine whether policyholders meet the benefit eligibility requirements outlined in their LTC policy.
The Care Manager, RN will complete and document Chronically Ill Certifications (CICs) and develop Plans of Care (POCs) for initial claims and ongoing recertifications, ensuring determinations are clinically sound, and policy aligned.
Key Responsibilities
Qualifications
At Wellcove, we strive to create an inclusive culture for all. We understand the importance of listening and incorporating various perspectives at every level of service. Our company does not discriminate based on gender identity, race, sexual orientation, age, religion, or disability.
Wellcove has been recognized as the nation's leading full-service senior market solutions provider for over 25 years. Our solutions span the insurance senior market sector, focusing on long-term care and Medicare Supplement plans. However, we don't stop there. Wellcove also addresses challenges faced in accident & health, disability, and supplemental health insurance programs.
Our team provides individuals and their families with peace of mind knowing their insurance needs will be met in a thoughtful, efficient manner. We are able to do this because of our dedicated associates, innovative solutions, and state-of-the-art technology.
We are seeking an experienced Registered Nurse (RN) to serve as a Care Manager supporting Long Term Care (LTC) insurance claims. This individual contributor role is responsible for conducting comprehensive clinical eligibility reviews to determine whether policyholders meet the benefit eligibility requirements outlined in their LTC policy.
The Care Manager, RN will complete and document Chronically Ill Certifications (CICs) and develop Plans of Care (POCs) for initial claims and ongoing recertifications, ensuring determinations are clinically sound, and policy aligned.
Key Responsibilities
- Perform detailed clinical reviews of LTC claim files to determine eligibility in accordance with policy provisions and regulatory requirements.
- Assess Activities of Daily Living (ADLs), cognitive impairment, diagnoses, comorbidities, and level of care needs.
- Review medical records, Minimum Data Set (MDS) assessments, facility documentation, home health records, daily visit notes, and supporting claim forms.
- Determine whether the insured meets the policy definition of Chronically Ill.
- Prepare and document Chronically Ill Certifications (CICs) and individualized Plans of Care (POCs) for initial approvals and recertifications.
- Clearly document clinical rationale to support benefit determinations.
- Collaborate with Claims, Eligibility, and Customer Service teams to obtain additional documentation when necessary.
- Maintain knowledge of LTC policy language, benefit triggers, and regulatory requirements.
Qualifications
- Active, unrestricted Registered Nurse (RN) license required.
- Clinical experience in long-term care, home health, geriatrics, case management, or utilization review preferred.
- Experience reviewing medical records and assessing functional and cognitive impairment.
- Knowledge of LTC insurance benefit triggers, ADL requirements, and chronically ill certification standards preferred.
- Strong clinical judgment, critical thinking, and documentation skills.
- Ability to manage multiple cases and meet turnaround expectations.
At Wellcove, we strive to create an inclusive culture for all. We understand the importance of listening and incorporating various perspectives at every level of service. Our company does not discriminate based on gender identity, race, sexual orientation, age, religion, or disability.