Job is Expired
Location: Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin
Compensation: Salary
Staff Reviewed: Fri, Jan 13, 2023
Job Summary
A non-profit health insurance company is searching for a person to fill their position for a Remote Health Insurance Appeals Registered Nurse.
Individual must be able to fulfill the following responsibilities:
- Utilize clinical knowledge and clinical review judgment to conduct medical review of claim documentation for first-level appeal cases
- Provide clear and concise written explanations for reason a specific claim or set of claims
- Analyze referrals and identify specific high-volume problem issues and relay information to Redeterminations Manager and Senior Analyst
Qualifications for this position include:
- Active RN license, applicable to state of practice
- Bachelor’s Degree in related field or
- Equivalent post high school and/or related work experience
- Ability to utilize clinical knowledge and clinical review judgment to conduct medical review of claim documentation
- Ability to analyze referrals and identify specific high-volume problem issues and relay information
