Remote Insurance Claims Review RN Job Opportunity

Join the Mission: Redefining Healthcare, One Claim at a Time

Imagine a place where your nursing expertise doesn't just heal individuals, but transforms the future of healthcare claims nationwide. That place is here. As a Remote Insurance Claims Review RN, your professional insight will shape outcomes, ensure fairness, and deliver quality assurance—all from the comfort of your own space. No scrubs. No fluorescent lights. Just purpose, autonomy, and the power to change lives one decision at a time.

We're more than a team—we're a movement. Fueled by empathy, precision, and creativity, we believe that every claim is more than paperwork; it's a person, a story, a life. And we want YOU to be a part of that story.

🚀 What You'll Be Doing: Beyond Routine, Toward Revolution

✍️ Clinical Judgement Meets Digital Intelligence

• Review complex medical claims with the precision of a seasoned RN and the objectivity of Sherlock Holmes on a health mission.
• Assess documentation for medical necessity, treatment appropriateness, and alignment with policy guidelines.
• Identify inconsistencies or potential fraud using both your clinical lens and data-backed tools.

🌐 Collaborate Remotely, Impact Nationally

• Communicate with claims adjusters, physicians, and case managers in a virtual environment.
• Offer a clear, defensible rationale for approvals, denials, or recommendations.
• Provide valuable clinical context to help non-clinical reviewers understand the nuances of medical care.

⌚ Keep It Fresh, Keep It Compliant

• Stay updated on current coding practices (ICD-10, CPT), clinical guidelines, and industry trends.
• Participate in internal audits and quality improvement initiatives.
• Inject innovation into traditional workflows by suggesting better methods of case handling.

🏡 Your Workspace: Cloud-Based & Coffee-Optional

Forget sterile hallways. Your new workspace is wherever your Wi-Fi flows. Whether it's a sunlit kitchen nook or a minimalist home office with a fern named "Susan," your remote haven is the new frontier.

This is a high-performance, high-respect environment. While we honor flexibility, we champion excellence. Expect structured autonomy, virtual camaraderie, and an abundance of Slack emojis to rival a teenager's phone.

⚖️ Tech + Tools = Your New Superpowers

• Secure claims management platforms for easy case review.
• Advanced EHR systems allow for quick access to clinical records.
• Real-time communication tools to connect with teammates without disrupting your Spotify playlist.
• AI-assisted flagging tools that surface high-risk claims without compromising human judgment.

🚀 What You Bring to the Table

🎓 Core Qualifications

• Active RN license (multi-state compact license a huge plus).
• At least three years of hands-on nursing practice in hospital settings, care coordination, or clinical review.
• Prior experience in insurance or medical claims review preferred (but not required—we love fast learners).

✨ Your Professional Secret Sauce

• Exceptional analytical and critical-thinking abilities.
• Clear, concise written communication skills for crafting rock-solid clinical justifications.
• Adaptability: Comfortable toggling between clinical documents, systems, and stakeholders.
• Tech confidence: Not just clicking buttons, but understanding how digital tools empower your judgment.

☀️ Growth, Learning & Liftoff

We don't just offer a job—we offer a launchpad. Every member of our team has access to ongoing learning, mentorship from industry leaders, and opportunities to expand into roles like Clinical Quality Auditor, Utilization Management Specialist, or Policy Development RN. We fuel your fire, not just your inbox.

🎁 Perks That Pack a Punch

• Annual salary: $81,090 (and yes, it's as competitive as it sounds)
• Fully remote setup (your couch has never looked so professional)
• Paid time off that doesn't require five layers of approvals
• Comprehensive coverage options such as medical, vision, and protection plans
• Mental wellness initiatives and ergonomic support (we’ve got your back—literally)
• Access to tech stipends and continuous learning reimbursements

✨ Be the Clinical Voice Claims Need

Let’s face it: insurance can be a jungle. But in this jungle, you're not just surviving—you're leading. Your clinical insights aren't buried in bureaucracy; they're front and center, helping people get what they need when they need it.

This is where smart meets heart, where you can do meaningful work and still have time to walk the dog, bake a lasagna, or conquer that Netflix series everyone’s raving about.

🛎️ Ready to Review with Purpose?

We’re not just hiring nurses. We’re recruiting visionaries. Nurses who believe that fairness matters, that technology is a tool for good, and that remote work doesn’t mean less impact.

So if you’re ready to wield your RN license like a scalpel in the digital age—precise, wise, and always human-first—we want to hear from you.

Apply today. Transform tomorrow. Let’s write the next chapter of claims review together.