State Licensed Clinical Claims Nurse

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