FREE ACCESS
5,000–10,000 jobs/day
See all jobs on JobTailor
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Claims Review Nurse
The NAIClaims Review Nurse resolving healthcare claim disputes for Capitol Bridge’s Florida and multi-state medical review programs. Assessing documentation, coordinating clinical reviewers, and drafting determinations.
Posted 8/23/2026full-timeRemote • Virginia • 🇺🇸 United StatesMid-LevelSenior💰 $75,000 - $85,000 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in nursing with a focus on claim review processes, including CPT coding and dispute resolution. Capable of collaborating with clinical professionals and legal teams while managing sensitive information and adhering to regulatory guidelines.
Highest-signal resume keywords
Active Nursing LicenseCPT Coding KnowledgeClaim Review ProcessesOrganizational SkillsVerbal Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claim ReviewCPT CodingMedical Necessity AssessmentQuality Assurance ProcessesDocumentation Preparation
Soft Skills
Organizational SkillsWritten Communication SkillsVerbal Communication SkillsCollaboration SkillsTask Prioritization
Tools & Technologies
Microsoft ExcelMicrosoft WordMicrosoft OutlookSharePointShareFile
Certifications & Qualifications
Active Nursing License
Industry Keywords
Dispute ResolutionHealthcare RegulationsPatient CareConfidential Information ManagementElectronic Document Management
About the role
Key responsibilities & impact- Conduct initial assessments of documentation from initiating and responding parties
- Review submissions, identify missing documents, and determine requirements for dispute resolution
- Obtain appropriate documentation according to established procedures
- Determine the appropriate clinical reviewer, such as a medical coder or physician
- Prepare case documents and provide instructions to assigned clinical reviewers
- Collaborate with the legal team to resolve disputes
- Draft professional determination letters
- Communicate with enrollees, health plans, and providers as needed
- Deliver determinations within required timelines
- Apply CPT code knowledge
- Participate in required meetings
- Collaborate with credentialed clinical professionals to determine medical necessity
- Use governmental and professional guidelines to assess appropriateness of services and procedures
- Adhere to company policies, state regulations, and project guidelines
- Complete reviews within assigned deadlines and follow QA/QC processes
- Uphold scheduling commitments and privacy regulations
- Perform other related duties as directed by leadership
Requirements
What you’ll need- Maintain an active license in nursing
- Five years of full-time equivalent experience providing direct care to patients
- Hold a non-restricted nursing license in any state in the US
- Knowledge of claim review processes including billing, Current Procedural Terminology (CPT) coding, and Explanation of Benefits
- Familiarization with electronic documents such as PDFs, Microsoft Excel, Microsoft Word, and Microsoft Outlook
- Familiarization with electronic data repositories such as SharePoint and/or ShareFile
- Exceptional skills in managing sensitive and confidential information
- Strong organizational, written, and verbal communication skills in English
- Ability to work independently and collaboratively with clinical reviewers, physicians, and attorneys
- Skilled in prioritizing tasks according to business needs and assignments
- Appeal and/or claim dispute-related experience preferred
- Successful completion of a background check is required
Benefits
Comp & perks- 🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account The NAI Website LinkedIn All Job Openings 1 - 10 employees Founded 2000 💼 Consulting 📣 Marketing 📱 Media Consulting
- Marketing
- Media The NAI is the Network Advertising Initiative, a self-regulatory trade association for the digital advertising and ad tech industry focused on responsible data collection and consumer privacy. It develops privacy principles and a self-regulatory framework, conducts privacy reviews and guidance, publishes policy comments and educational resources (e. g. , on privacy-enhancing technologies), and advocates on digital advertising and privacy policy while supporting member compliance and opt-out mechanisms. Claims Review Nurse Job not on LinkedIn 🔥 2 hours ago ⚔️ Virginia – Remote 💵 $75k - $85k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 👻 Ghost score 0% Apply Now Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
- Conduct initial assessments of documentation from initiating and responding parties
- Review submissions, identify missing documents, and determine requirements for dispute resolution
- Obtain appropriate documentation according to established procedures
- Determine the appropriate clinical reviewer, such as a medical coder or physician
- Prepare case documents and provide instructions to assigned clinical reviewers
- Collaborate with the legal team to resolve disputes
- Draft professional determination letters
- Communicate with enrollees, health plans, and providers as needed
- Deliver determinations within required timelines
- Apply CPT code knowledge
- Participate in required meetings
- Collaborate with credentialed clinical professionals to determine medical necessity
- Use governmental and professional guidelines to assess appropriateness of services and procedures
- Adhere to company policies, state regulations, and project guidelines
- Complete reviews within assigned deadlines and follow QA/QC processes
- Uphold scheduling commitments and privacy regulations
- Perform other related duties as directed by leadership 🎯 Requirements
- Maintain an active license in nursing
- Five years of full-time equivalent experience providing direct care to patients
- Hold a non-restricted nursing license in any state in the US
- Knowledge of claim review processes including billing, Current Procedural Terminology (CPT) coding, and Explanation of Benefits
- Familiarization with electronic documents such as PDFs, Microsoft Excel, Microsoft Word, and Microsoft Outlook
- Familiarization with electronic data repositories such as SharePoint and/or ShareFile
- Exceptional skills in managing sensitive and confidential information
- Strong organizational, written, and verbal communication skills in English
- Ability to work independently and collaboratively with clinical reviewers, physicians, and attorneys
- Skilled in prioritizing tasks according to business needs and assignments
- Appeal and/or claim dispute-related experience preferred
- Successful completion of a background check is required Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Registered Nurse, Reviewer 🕒 Yesterday AMDEX Corp 51 - 200 💼 Consulting 🏥 Healthcare 📦 Logistics Website LinkedIn All Job Openings Registered Nurse reviewing Medicare records and preparing physician-review cases for Avar Consulting’s policy research programs. Supporting audits, quality assurance, and Medicare FFS/MA documentation. 🇺🇸 United States – Remote 💵 $60k - $75k / year ⏰ Full Time 🟢 Junior 🟡 Mid-level Oncology Nurse Educator 🕒 Yesterday AstraZeneca 10,000+ employees 💊 Pharmaceuticals 🧬 Biotechnology 🏥 Healthcare Website LinkedIn All Job Openings Oncology Nurse Educator delivering clinical education for AstraZeneca’s lung and GI cancer medicines. Engaging healthcare providers across the Northwest and supporting patient care strategies. 🇺🇸 United States – Remote 💵 $151.1k - $226.6k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior Triage Nurse – RN 🕒 Yesterday SCP Health 5001 - 10000 🏥 Healthcare 🤝 B2B 🎯 Recruiter Website LinkedIn All Job Openings Remote Triage Nurse providing telephonic assessment, education, and care direction for SCP Health’s clinical practice management network. Night-shift RN role serving patients across the United States. 🇺🇸 United States – Remote 💵 $27 - $40 / hour ⏰ Full Time 🟢 Junior 🟡 Mid-level Registered Nurse, Triage Call Agent 🕒 Yesterday IMH 501 - 1000 🏗️ Construction 📦 Logistics 🛡️ Insurance Website LinkedIn All Job Openings Registered Nurse triaging and educating patients by phone for Intermountain Health’s clinical communication center. Assessing needs, documenting calls, and directing patients to appropriate care. 🇺🇸 United States – Remote 💵 $37 - $57 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior Registered Nurse Education Coordinator 🕒 Yesterday Trinity Health 10,000+ employees 🏥 Healthcare 🤝 Non-profit 🏨 Hospitality Website LinkedIn All Job Openings Registered Nurse Education Coordinator developing educational plans for FirstChoice Iowa Regional programme. Facilitating staff learning, competency, and development remotely. 🇺🇸 United States – Remote 🔥 Funding within the last year 💰 $20k Grant - Trinity Health on 2025-10 ⏰ Full Time 🟡 Mid-level 🟠 Senior 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates About us Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course Remote Job Search MasterClass Resume Review AI Apply Copilot OpenClaw job finder API docs Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs