About Us

Zipliens is a leading lien resolution company that specializes in streamlining the lien process for personal injury law firms. We are looking for proactive, results-driven individuals to join our dynamic team.

Job Description

Zipliens is seeking a Nurse Claims Analyst to provide clinical expertise that strengthens the accuracy and reliability of our Mass Tort lien resolution process. Health plans often submit reimbursement claims that include extensive medical itemizations, and it is critical that only treatment directly related to the underlying litigation is considered. The Nurse Claims Analyst will leverage clinical judgment and familiarity with medical coding (ICD/CPT) to support this process, ensuring reviews are accurate, consistent, and defensible.

As a clinical Subject Matter Expert (SME), the Nurse Claims Analyst will support the development of clear review protocols, provide guidance on complex or disputed claims, and contribute to process improvements that uphold the highest standards of quality and fairness.

Requirements

Responsibilities

Conduct high-volume QA reviews of claimant-level medical records (up to 1,000 per week), using clinical judgment and knowledge of medical coding to determine relatedness to the underlying litigation
Help create and establish medical claim audit protocols to enable consistent and defensible determinations
Use Excel/Google Sheets to efficiently manage and analyze large datasets, creating workflows that streamline reviews and reduce the need for one-off line-by-line analysis
Document review findings and rationales clearly and accurately for use by internal teams and clients
Identify trends or recurring issues in claim reviews and recommend updates to processes or protocols to improve consistency and accuracy
Support knowledge sharing by documenting review standards and providing clinical guidance to internal team members and vendors
Adapt review approach across multiple claim types to meet evolving client and project needs
Ensure reviews and determinations meet accuracy, quality, and productivity standards that support reliable client outcomes
Contribute subject matter expertise to reports, analysis, and special projects that strengthen review protocols and client deliverables

Qualifications

3+ years of experience in medical record review, claims auditing, or medical billing and coding
1+ years of experience in itemized bill review (or equivalent claims review experience)
Active, unrestricted RN license in good standing within the United States is required
Strong understanding of payer policies and medical coding systems such as CPT, ICD-9/10, and HCPCS
Proficiency in Excel (e.g., formulas, pivot tables, data analysis) to efficiently manage and evaluate large claim datasets
Excellent written communication skills, including the ability to write clear, concise, and fact-based rationales in support of determinations
Ability to evaluate medical information and apply clinical judgment to make defensible determinations on claim appropriateness

Benefits

Private Health Care Plan (Medical, Dental & Vision)
Company HSA contributions for HDHP participants
Flexible Spending Accounts (Health & Dependent Care)
Company-Paid Short-Term Disability Coverage
Voluntary Long-Term Disability, Life, AD&D, and Supplemental Coverage Options
401(k) Plan with Company Match
Paid Time Off (Vacation, Sick Time & Select Holidays)
Paid Maternity & Paternity Leave
Remote-First Work Environment

Pay Disclosure: In the states of CA, CO, CT, NV, NY, RI, WA, the total base salary range for this role is $75,000 - $90,000 annually. Final compensation will be determined based on skills and experience.

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Nurse Claims Analyst