CVS Health is currently hiring Remote Registered Nurses (RNs) for Medical Claims Reviewer roles. This position is designed for experienced RNs who want to move into the non-clinical side of healthcare while still making a significant impact. You'll be responsible for reviewing, assessing, and processing medical claims in alignment with clinical guidelines, coverage policies, and regulatory compliance standards—all from a remote work environment.
This is a perfect opportunity for RNs seeking a shift away from direct patient care into healthcare administration, insurance processing, or quality review.
Job Overview:
Job Title: Medical Claims Reviewer (Remote RN)
Company: CVS Health
Location: Remote (United States only)
Employment Type: Full-Time
Salary Range: $75,000 – $95,000 per year
Key Responsibilities:
Review incoming medical claims and supporting documentation
Evaluate clinical appropriateness and coverage eligibility
Identify coding errors or discrepancies
Collaborate with providers or internal departments on claims clarification
Ensure compliance with state and federal regulations, including HIPAA
Qualifications:
Active RN license (U.S.)
3+ years of clinical nursing experience
Prior experience in claims review, case management, or utilization review
Strong understanding of ICD-10, CPT codes, and payer systems
Detail-oriented with excellent analytical skills
Proficient with healthcare software and EHR systems
Ability to work independently in a secure, remote environment
Benefits:
Competitive annual salary
Remote-first position with flexible schedule
Full healthcare and dental benefits
Paid time off, holidays, and 401(k)
Opportunities for advancement into compliance or clinical review leadership
How to Apply:
Interested candidates should apply through the CVS Health careers portal, submitting a current resume, RN license, and any certifications in claims or utilization review. Interviews are held virtually. Multiple remote roles are open across the U.S.