Clinical Claims Nurse

Job Title: Clinical Claims Nurse Location: 100% Remote Pay Rate: $36.25/hour on W-2 (Contract-to-Hire), $65K conversion salary Schedule: M–F, 8-hour shifts (Core hours: 9am–3pm ET) Akkodis is hiring a Clinical Claims Nurse for a fully remote contract-to-hire opportunity with a leading healthcare compliance organization. This role is ideal for professionals with medical coding, medical billing, and insurance claims experience at a health plan (e.g., Humana, BCBS, UnitedHealthcare). If you're detail-oriented, tech-savvy, and enjoy problem-solving in a structured yet fast-paced environment, this role offers a great opportunity to apply your coding and payer-side experience in a meaningful way.

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. Use your knowledge of remark codes, CPT codes, and medical service codes to make impartial and binding recommendations. Handle 24+ insurance dispute cases per day, documenting decisions accurately in the CMS IDR Portal.