State Licensed Clinical Claims Nurse

Job Summary

A company is looking for a Clinical Claims Nurse for a fully remote contract-to-hire opportunity.

Key Responsibilities

• Review Explanation of Benefits (EOBs) and appeals from providers and health plans under the No Surprises Act
• Resolve disputes related to out-of-network provider charges by following detailed internal policies
• Research service codes, fees, and coverage policies using digital tools and online databases

Required Qualifications

• 3+ years of clinical nursing experience (ICU, ER, Med Surg, or PACU) and electronic charting experience
• Experience handling insurance claims from the payer side (e.g., Humana, BCBS, Aetna)
• Must hold an active RN or LPN license
• Associate's degree or higher required
• Familiar with dispute resolution, appeals processes, and healthcare regulations