Job Summary

We are seeking a Bilingual Registered Nurse - Remote for a temp-to-hire opportunity supporting clinical claims review in the healthcare services industry. This role is ideal for a licensed Registered Nurse or certified coding professional who is detail-oriented, analytical, and interested in applying clinical knowledge outside of direct patient care.

In this remote position, you will review claims against medical records, evaluate whether services are supported, and help ensure compliance with reimbursement, contract, state, and federal guidelines. This opportunity offers structured expectations, collaboration with knowledgeable internal teams, and the chance to build valuable experience in clinical review, claims resolution, and healthcare compliance.

The work environment is designed for professionals who value accuracy, teamwork, and clear communication. Candidates can expect supportive leadership, defined performance standards, and opportunities to contribute to process improvement while working in a remote healthcare operations setting.

Key Responsibilities

- Perform clinical reviews of professional or facility claims compared with medical records to determine whether claims are supported or unsupported.
- Maintain departmental standards for productivity, accuracy, documentation, and clinical review quality.
- Provide clear clinical logic to providers and internal teams when claim determinations require explanation.
- Investigate, recover, and resolve claims for health plans, commercial customers, and government entities.
- Ensure adherence to state and federal compliance policies, reimbursement policies, and contract requirements.
- Participate in internal customer meetings, provide feedback, and support continuous improvement across team processes.

Compensation and Benefits

- Pay rate: $21 per hour.
- Job type: Temp-to-hire.
- Work arrangement: Remote.
- Location: San Juan, PR.

Required Qualifications and Skills

- Conduct clinical case reviews using medical records, claims data, and applicable documentation standards.
- Investigate claims issues and support recovery, resolution, and compliance processes.
- Document findings clearly while maintaining data integrity, data security, and process accuracy.
- Collaborate with internal teams to improve communication, workflow, and department relationships.

- Active Puerto Rico Registered Nurse license or applicable coding certification.
- Accepted certifications may include CPC, CPC-A, CIC, COC, CPMA, or CCS.
- Less than 1 year of experience may be considered if licensing or certification requirements are met.
- Demonstrated computer proficiency and ability to work accurately in healthcare systems and documentation tools.
- Ability to interpret medical records, claims information, reimbursement requirements, and compliance guidelines.
- Strong attention to detail, analytical thinking, and problem-solving skills.
- Ability to communicate clinical findings clearly and professionally in a remote work environment.
- Bilingual communication skills appropriate for a professional healthcare setting.

Preferred Qualifications

- Experience reviewing healthcare claims, medical records, or clinical documentation.
- Familiarity with health plan operations, claims recovery, reimbursement policies, or government healthcare programs.
- Prior remote work experience in a healthcare, clinical review, coding, or claims environment.

Equal Opportunity Employer / Disabled / Protected Veterans

The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.