Top 185 Claims Jobs in Montpelier, Vt

Medical Director - Exempt
State of Vermont - Department of Corrections —Waterbury, VT
- $175,000 - $250,000 a year
- Weekends as needed
- Medicine
- Microsoft Excel
- 5 years
Human Resources Generalist, Leave Administration & Compliance
Darn Tough Vermont / Cabot Hosiery Mills —Northfield, VT
- $80,000 - $90,000 a year
- Full-time
- 5 years
- Mid-level
- Office
- Military leave
Quick Apply
10d
Surveillance Investigator
Allied Universal® Compliance and Investigations —Montpelier, VT
- From $23 an hour
- Weekends as needed
- Microsoft Word
- Military
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
Surveillance Investigator
Allied Universal® Compliance and Investigations —Montpelier, VT
- From $23 an hour
- Weekends as needed
- Microsoft Word
- Military
- Mid-level
- AD&D insurance
- Paid holidays
Quick Apply
Billing Manager
Clara Martin Center —Randolph, VT
- $26.44 - $28.50 an hour
- Full-time
- Background check
- System design
- Bachelor's degree
- 403(b) matching
- Health savings account
Quick Apply
Mental Health Therapist - Remote
Guideline Healthcare —Vermont
- Up to $100,000 a year
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Employee discount
- Flexible schedule
Quick Apply
7d
Claims Analyst - REMOTE
Ryder System —Montpelier, VT
- $90,000 - $100,000 a year
- Full-time
- Remote
- Bachelor's degree
- Experience equivalent to degree accepted
- Senior level
- Disability insurance
- Health insurance
Senior Claims Representative - REMOTE
Ryder System —Montpelier, VT
- $75,000 - $80,000 a year
- Remote
- Management
- 5 years
- Bachelor's degree
- Disability insurance
- Health insurance
13d
SIU Claims Investigator
Lemieux & Associates LLC —Montpelier, VT
- $25 - $32 an hour
- Part-time
- Bilingual
- Computer literacy
- Mid-level
- Flexible schedule
Quick Apply
Workers Compensation Claim Representative
Vermont League Of Cities and Towns —Montpelier, VT
- $62,000 - $75,000 a year
- Full-time
- Public speaking
- High school diploma or GED
- Driver's License
- Work from home
Quick Apply
9d
Encounters Technical Analyst
CVS Health —Montpelier, VT
- $46,988 - $122,400 a year
- Full-time
- SQL
- Analysis skills
- Bachelor's degree
- Health insurance
- Dental insurance
Casualty Claims Specialist (UM)
Norfolk & Dedham | Union Mutual Insurance Group —Montpelier, VT
- $74,000 - $100,000 a year
- Hybrid work
- 7 years
- Computer literacy
- Bachelor's degree
Quick Apply
Client Advocate I
CVS Health —Montpelier, VT
- $43,888 - $102,081 a year
- Full-time
- Microsoft Outlook
- Mid-level
- Administrative experience
- Health insurance
- Dental insurance
6d
Network Management Analyst
CVS Health —Montpelier, VT
- $43,888 - $102,081 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Research
- Health insurance
- Dental insurance
Human Resources Generalist - Norwich University
Norwich University —Northfield, VT
- Weekends as needed
- Hybrid work
- Background check
- Microsoft Outlook
- English
Market Conduct PBM Examiner
State of Vermont - Department of Financial Regulation —Montpelier, VT
- $32.87 - $51.52 an hour
- Multiple hires
- Writing skills
- Data analysis skills
- Mid-level
- Wellness program
- Paid holidays
Director, Portfolio Management
National Life Insurance Company —Montpelier, VT
- $127,500 - $187,000 a year
- Hybrid work
- 11+ years
- Office
- Analysis skills
- Adoption assistance
- Benefits from day one
People & Culture Manager
Agri-Mark/Cabot Creamery —Cabot, VT
- $100,000 - $125,000 a year
- 5 years
- Analysis skills
- Bachelor's degree
- Tuition reimbursement
- 401(k) matching
Quick Apply
Litigation Operations Consultant, Projects & Technology – Remote
CSAA Insurance Services, Inc. —Montpelier, VT
- $110,700 - $147,500 a year
- Full-time
- 8 years
- US work authorization
- Senior level
- 401(k) matching
13d
Lead Director, Stop Loss Relationship Management
CVS Health —Montpelier, VT
- $100,000 - $231,540 a year
- Full-time
- Bachelor's degree
- Fair chance
- Experience equivalent to degree accepted
- Health insurance
- Dental insurance

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claims jobs near montpelier, vt

Medical Director - Exempt

State of Vermont - Department of Corrections
Waterbury, VT

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Job Details

Full-time
$175,000 - $250,000 a year

Qualifications

Optimizing workflow processes
Clinical program budget management
Staff supervision
Microsoft Excel
Team supervision
BC/BE
Word embeddings
Employee relationship building
Team development
Medical License
Clinical team leadership
Budget preparation
Productivity software
Task assignment
Team motivation (leadership skill)
Technical Proficiency
Budget review

Full Job Description

Overview

The Medical Director (MD) reports directly to the Health Services Division Director within the Department of Corrections’ Office of Health, Wellness, and Engagement (HWE) and is responsible for providing medical expertise to the health system to drive quality improvement. The MD will collaborate closely with other members of DOC’s HWE. The MD will collaborate with and oversee clinical activities and work collaboratively across the Agency of Human Services (AHS) Departments in the interest of improving clinical programs while identifying effective and efficient ways to continually improve services and focus on improving the patient’s experience of care, including quality and satisfaction, and improving the health outcomes of AHS populations.

The MD assists in resolving patient issues, develops quality and outcome measures to support overall health outcome improvements, represents the department at internal and external meetings. Serves as a clinical expert assisting and guiding departments clinical and non-clinical staff as it relates to best practice, standards of care that are evidence based. The MD will coordinate and collaborate with the department’s contracted comprehensive health services provider.

PRIMARY RESPONSIBILITIES:

Provide clinical support for review and adoption of all clinical guidelines.

Provide peer review of medical contractor’s clinical care audits and continuous quality improvement studies, as well as directly auditing contracted medical providers.

Provide independent physician oversight for high-risk and complex cases.

Enhance coordination and continuity of care through expert consultation.

Provide expertise regarding implementation of care outcomes metrics and initiatives to improve these outcomes.

Ensure DOC’s compliance with National Commission on Correctional Health Care standards including support during re-accreditation processes.

Strengthen the department’s internal clinical governance and compliance with healthcare standards.

Engage in discussions of clinical matters with external stakeholders such as physicians and other clinicians as well as Agency of Human Services and associated department staff as needed.

Review and evaluation of complex sentinel events, including identifying findings that need to be incorporated into continuous quality improvement processes.

Oversight and guidance in the management of diabetes, opioid use disorder, and other chronic conditions.

Participation in case reviews and system-level quality improvement efforts.

Provide medical expertise for utilization management and care management programs including internal programs and programs provided under contract or delegated to external entities, i.e.: AHS sister departments.

Provide clinical expertise coverage for the Health Services Division on evenings and weekends on a rotating basis, monitoring work communication channels to escalate or respond if emergency issues arise that need DOC support and/or intervention.

Support other AHS sister departments to advise on medical needs and policies as requested.

Competencies, Knowledge, Skills & Abilities

Experience and Subject Matter Expertise

Attainment of M.D. or D.O. degree and Board Certification in an ABMS approved specialty. Addictionology certification or expertise in substance use disorder treatment preferred.
Current license to practice medicine in Vermont
Meets Vermont Medicaid credentialing standards
At least five years of clinical practice experience
Demonstrated success in a medical management leadership role
Expert knowledge of care management and quality improvement programs
Understanding of national and Vermont health reform initiatives
Experience providing healthcare to underserved communities with significant health risks.
Experience treating patients with acute and complex medical needs, such as but not limited to co-occurring substance use disorder, mental health, and medical disorders and conditions.
Experience with EQRO standards and process.
Familiarity with electronic health record systems

Computer Skills (or other technical skills) – Must have functional knowledge of Microsoft Office including Word, Excel, and PowerPoint.

Process Improvement Knowledge and Abilities – A strong ability to examine and document work processes, identify and recommend improvements in efficiency and effectiveness, and build procedures to ensure that successful results will be replicated is required.

Communication Skills – Excellent verbal and written communication skills.

Interpersonal Skills – Advanced ability to build effective relationships (within company, within broader community), work effectively in a team-based environment, motivate, build consensus, negotiate, persuade, facilitate, resolve conflicts, demonstrate tact/sensitivity, and observe confidentiality.

Organizational Abilities – Advanced ability to effectively prioritize work, multitask, direct/participate in group, demonstrate both independence and interdependence, exercise judgment, and work effectively in fast paced environment. Experience and skill in change management important.

Analytical Skills – Advanced ability to analyze clinical data from medical and pharmacy claims and medical record reviews to determine cost, quality, and efficiency of practice patterns

Leadership – This position requires proficiency building commitment and motivation in others toward the achievement of shared goals by effectively staffing, delegating and empowering, monitoring progress, providing feedback, and taking corrective action when appropriate. Strong budget development knowledge and budget administration skills are also required.

Commitment to health equity – Must display commitment to expanding healthcare access, enhancing healthcare quality and improving health outcomes for Vermonters who experience systemic barriers that can contribute to poor health outcomes, such as identity-based discrimination or involvement in the criminal justice system.

Compensation

Anticipated approximate starting annual salary range for this positon is from $175,000 to $250,000.

Who May Apply

This position, Medical Director - Exempt (Job Requisition #54979), is open to all State employees and external applicants.

If you would like more information about this position, please contact [email protected].

Resumes will not be accepted via e-mail. You must apply online to be considered.

Please note that multiple positions in the same work location may be filled from this job posting.

Minimum Qualifications

Qualified candidates must possess an M.D. or a D.O. with an active Vermont medical license in good standing. Position requires at least five (5) years of clinical experience, three (3) of which must have involved leadership and management experience in the health care industry.

DOC PREA (Prison Rape Elimination Act) Requirements

In accordance with federal regulation, any person applying for employment in the Department of Corrections must provide relevant information. Previous institutional employers will be contacted and required to provide information regarding substantiated incidences of sexual abuse or resignation during a pending investigation of an allegation of sexual abuse. By submitting this online job application, you certify all information furnished is true and complete. The information you provide in accordance with this regulation may be used, and previous employers may be contacted for the purpose of investigating and verifying your work history.

Conviction History Requirements: Candidates who have any felony conviction record or who, within the past five (5) years, have been placed under supervision or sanctioned for a misdemeanor conviction must receive a waiver from the Commissioner of Corrections in order to be considered for employment. You may access the application and corresponding documents by clicking here. Once you have completed the application, please send it directly to the hiring manager identified as the contact person in this job posting.

Equal Opportunity Employer

The State of Vermont celebrates diversity, and is committed to providing an environment of mutual respect and meaningful inclusion that represents a variety of backgrounds, perspectives, and skills. The State does not discriminate in employment on the basis of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, membership in an employee organization, family medical history or genetic information, or family or parental status. The State’s employment decisions are merit-based. Retaliatory adverse employment actions by the State are forbidden.

Apply Now

Refine Your Search

claims jobs in montpelier, vt

Medical Director - Exempt

Human Resources Generalist, Leave Administration & Compliance

Surveillance Investigator

Surveillance Investigator

Billing Manager

Mental Health Therapist - Remote

Claims Analyst - REMOTE

Senior Claims Representative - REMOTE

SIU Claims Investigator

Workers Compensation Claim Representative

Encounters Technical Analyst

Casualty Claims Specialist (UM)

Client Advocate I

Network Management Analyst

Human Resources Generalist - Norwich University

Market Conduct PBM Examiner

Director, Portfolio Management

People & Culture Manager

Litigation Operations Consultant, Projects & Technology – Remote

Lead Director, Stop Loss Relationship Management

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Overview

Competencies, Knowledge, Skills & Abilities

Compensation

Who May Apply

Minimum Qualifications

DOC PREA (Prison Rape Elimination Act) Requirements

Equal Opportunity Employer

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