State Licensed Clinical Claims Nurse

Job Summary

Utilizing clinical judgment, the full-time State Licensed Clinical Claims Nurse will review and interpret clinical documentation, apply clinical decision-making for post-service claims, and coordinate clinical resolutions while working remotely.

Key responsibilities

• Review and interpret clinical documentation from medical records or systems
• Apply clinical criteria and policies for post-service claims and coordinate resolutions
• Act as a resource for customer service and claims processing teams, while training new and existing staff

Required qualifications

• Nursing degree (RN)
• A minimum of 2-3 years of professional experience as a licensed Registered Nurse (RN) or equivalent clinical experience
• Strong analytical skills to assess medical claims