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Rn Insurance Claims Jobs (NOW HIRING)

CHI Health Clinic

RN Workers Comp Coordinator

Omaha, NE · On-site

$29.36 - $43.68/hr

Communicate with nurse case managers, insurance claims adjusters, and human resource personnel to ... Current Registered Nurse (RN) license that allows you to practice in our state * Graduate of an ...

Medlogix

$85K/yr

Field Case Nurse Manager - RN (Northern New Jersey) Full-Time Professional Hamilton, NJ, US 6 days ... insurance claims process. The result is lower expenses and increased productivity for the auto ...

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How much do rn insurance claims jobs pay per hour?

As of Sep 12, 2026, the average hourly pay for rn insurance claims 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 is an RN Insurance Claims?

An RN Insurance Claims job involves using nursing expertise to review medical claims, assess the necessity of treatments, and ensure compliance with insurance policies. These professionals work for insurance companies, healthcare organizations, or third-party administrators to evaluate claims for accuracy and fraud detection. They may also collaborate with healthcare providers and policyholders to clarify medical documentation and coverage decisions. Their goal is to ensure fair and efficient claims processing while controlling costs and maintaining quality care standards.

What are the typical daily responsibilities of an RN Insurance Claims specialist?

As an RN Insurance Claims specialist, your daily tasks typically involve reviewing medical records, evaluating insurance claims for medical necessity, and providing clinical expertise to ensure proper claim processing. You may also consult with physicians, healthcare providers, and claims adjusters to clarify medical information or support appeals. Many roles require working in a team environment with other nurses, claims specialists, and administrative professionals. This position is ideal for detail-oriented nurses who enjoy applying their clinical expertise in a non-bedside setting while playing a key part in the healthcare reimbursement process.

What are the key skills and qualifications needed to thrive in the RN Insurance Claims position?

To thrive as an RN Insurance Claims specialist, you need active RN licensure, strong clinical assessment knowledge, and experience interpreting medical records. Familiarity with insurance claims management software, ICD-10 coding, and electronic health records is highly beneficial. Attention to detail, analytical thinking, and effective communication are key soft skills for this role. These skills ensure accurate claim evaluations, efficient case processing, and clear collaboration between healthcare providers and insurance companies.

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Rn Insurance Claims jobs near you
Infographic showing various Rn Insurance Claims job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 74% Full Time, 19% Part Time, and 6% Contract. Highlights an 88% Physical, 1% Hybrid, and 11% Remote job distribution, with an average salary of $48,885 per year, or $23.5 per hour.

Claims - Care Manager, RN, Claims

Pensacola, FL • On-site

Wellcove
See more jobs at Wellcoveexternal

Full-time

Re-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
  • 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.

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