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Anthem, Inc. Clinical Review Nurse I Medicare Part B - Fee for Service (REMOTE) in Syracuse, New York


SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At National Government Services (NGS), an independent subsidiary of Anthem, Inc. and one of the largest Medicare contractors in the country, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve.

Work Hours: East Coast business hours. Start/end time slightly flexible.

Location: This position will allow you to work from home but you must reside within 1 hour commute to one of the following NGS offices: Syracuse, NY; Harrisburg, PA; Denison, TX; Indianapolis, IN; or South Portland, ME.

The Clinical Review Nurse l (Medicare Part B – Fee for Service) position will be responsible for reviewing and making medical determinations as to whether a claim meets the benefits the member carries. Primary duties may include, but are not limited to:

  • Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials.



  • AS/BS in nursing; 1 year of clinical experience with an understanding of clinical experience; or any combination of education and experience, which would provide an equivalent background.

  • Current unrestricted RN license in state of residence required.

  • Ability to comprehend and interpret medical policy and criteria to clearly articulate health information.

  • Intermediate level proficiency using MS Word and Excel

  • Must reside within 1 hour commute of one of our offices in Harrisburg, PA; Syracuse, NY; Dennison, TX; or Indianapolis, IN.

Additional skills strongly preferred:

  • CMS (Centers Medicare Medicaid Services) experience.

  • Knowledge of Medicare Part B – Fee for Service a plus.

  • MCS claims system experience a plus.

  • Experience working in a virtual team.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.

REQNUMBER: PS39906-2495