Registered Nurse (Claims & Appeals Review)

Compunnel Inc. is where AI-native solutions meet human ingenuity, helping enterprises reimagine talent, technology, and growth. A world where your people and your platforms don’t just coexist — they co-elevate. At Compunnel, we build bridges between intelligent systems and human potential, forging paths to transformation in real time. For over 30 years, we’ve been the quiet force behind digital revolutions. We speak two languages fluently: empathy and algorithm. Our AI-powered infrastructure weaves into human workflows (not over them), enabling clients to scale with agility, adapt with foresight, and compete with confidence. From coast to coast in the U.S. (30+ delivery centers) and across global innovation hubs in Canada, India, and the UK, we serve 200+ clients — including 23% of the Fortune 500. Whether you’re a global enterprise or a public sector agency, you lean on us for recruitment (IT, non-IT, public sector) and future-forward digital capabilities. Twelve times ranked on the Inc. 5000 list for fastest-growing private companies, our core strengths lie in Software Development, Cloud, Data Analytics, AI/ML, and Cybersecurity. But what defines us is how we activate them — turning insights into outcomes, plans into momentum. We’re also proud to be a certified Minority Business Enterprise (MBE) in the U.S. and Canada. Inclusion isn’t just values-speak — it’s baked into our DNA. Our alliances with AWS, Microsoft, UiPath, Google Cloud, and more reflect a commitment to staying at the bleeding edge of AI innovation and co-creating centers of excellence with our clients. Let’s not just build technology. Let’s build a future that’s intelligent, inclusive, and impossible to ignore.

Job Title: Registered Nurse – Claims & Appeals Review Location: Remote (Anywhere in Florida) Duration: 06 Months/Can be Extended Working hours: Day Shift Job Type: Subcon Pay Rate: Negotiable Position Purpose: The Quality Analyst is responsible for ensuring the accuracy, compliance, and timeliness of appeal reviews through both manual and automated reporting mechanisms. This role supports continuous improvement in clinical operations by identifying quality gaps, performing root cause analysis, and recommending corrective actions.

Review appeal cases and supporting documentation to ensure completeness and compliance with InterQual and contractual guidelines. Conduct manual audits and reporting to assess quality of appeal decisions and documentation. Analyze operational data and performance metrics to identify trends, errors, and improvement opportunities. Collaborate with clinicians and MD reviewers to validate decisions and escalate complex cases. Maintain dashboards and SLA tracking for appeals turnaround time, audit coverage, and accuracy. Support calibration sessions and feedback loops with transaction monitors and team leads. Document findings and prepare reports for internal and client-facing reviews. Ensure compliance with NCQA, CMS, and state regulations.