Top 34 Claims supervisor Jobs in Vermont

RN Readmission Manager, Payment Integrity
Centene Corporation —Vermont
- $87,700 - $157,800 a year
- Full-time
- Remote
- Nursing
- RN License
- 3 years
- Paid holidays
- Health insurance
6d
Client Experience Manager, Pharmacy Benefits Management
CVS Health —Vermont
- $46,988 - $122,400 a year
- Full-time
- Remote
- 5 years
- High school diploma or GED
- Bachelor's degree
- Health insurance
- Dental insurance
10d
Administration Manager
Windham County Humane Society —Brattleboro, VT
- $22 - $24 an hour
- Part-time
- Background check
- Google Workspace
- Customer service
- 401(k)
- Paid time off
Quick Apply
Senior Claim Supervisor
Vermont Mutual —Montpelier, VT
- $105,000 - $135,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Office
Quick Apply
8d
Safety Manager
City of Burlington, Vermont —Vermont
- $87,977 - $98,179 a year
- Full-time
- Word processing
- Bachelor of Science
- Driver's License
- Disability insurance
- Health insurance
7h
Case Manager, Registered Nurse
CVS Health —Vermont
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- Addiction Medicine
- Health insurance
- Dental insurance
Benefits Manager
South Burlington School District (VT) —South Burlington, VT
- $67,000 - $74,000 a year
- Full-time
- 5 years
- Writing skills
- HIPAA
- Health savings account
- AD&D insurance
Safety & Health Manager
King Arthur Baking Company —White River Junction, VT
- $75,000 - $100,000 a year
- Full-time
- Senior level
- No travel
- Leadership
- Profit sharing
- Paid parental leave
Quick Apply
Manager, Medical Economics
CVS Health —Montpelier, VT
- $54,300 - $145,860 a year
- Full-time
- Remote
- Mid-level
- 3 years
- SQL
- Health insurance
- Dental insurance
6d
Manager, Actuarial Services
Centene —Vermont
- $134,600 - $249,000 a year
- Full-time
- Remote
- 5 years
- Research
- SQL
- Paid holidays
- Health insurance
Sr. Manager, AI Lead - Semantic Layer - Remote
CSAA Insurance Services, Inc. —Montpelier, VT
- $168,300 - $224,300 a year
- Full-time
- Remote
- Computer science
- Computer Science
- Product management
- 401(k) matching
22h
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
Area Manager
Lewis Services —Brattleboro, VT
- $105,000 - $120,000 a year
- Full-time
- Ability to walk for extended periods
- Ability to climb stairs
- Travel
- Paid training
- Health savings account
Case Manager - Washington and Orange counties
COLUMBUS MEDICAL SERVICES LLC —Burlington, VT
- $30 an hour
- Full-time
- Remote
- Background check
- Pass drug screening
- Research
Quick Apply
12d
RN Case Manager/Care Coordinator
US Veterans Health Administration —White River Junction, VT
- $79,295 - $138,124 a year
- Part-time
- Background check
- Nursing
- Psychiatry
- Paid holidays
- Dental insurance
1d
Controller / Human Resources Manager
Firetech Sprinkler Corp. —Colchester, VT
- $100,000 - $125,000 a year
- Full-time
- Management
- 5 years
- Office
- Profit sharing
- Health savings account
Quick Apply
13d
Case Manager -Addison County, Vermont
COLUMBUS MEDICAL SERVICES LLC —Middlebury, VT
- $30 an hour
- Full-time
- Remote
- Background check
- Pass drug screening
- Research
Quick Apply
8d
MDF Manager
New Charter Technologies, Inc. —Vermont
- $55,000 - $70,000 a year
- Full-time
- Remote
- Mid-level
- Organizational skills
- Communication skills
Quick Apply
Senior Project Manager - Highway Engineering - Burlington, VT
Hoyle, Tanner & Associates, Inc. —Burlington, VT
- $70 - $76 an hour
- 5 years
- Bachelor of Science
- Office
- Flexible schedule
Quick Apply
Pharmacy Operations Manager
Walgreens —Brattleboro, VT
- $22.50 - $31.00 an hour
- Weekends as needed
- English
- Mid-level
- High school diploma or GED
- Continuing education credits
- Health insurance

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claims supervisor jobs near vermont

RN Readmission Manager, Payment Integrity

Centene Corporation -
Vermont

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Job Details

Full-time
$87,700 - $157,800 a year
6 days ago

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Medical claims processing software
Healthcare team management
Healthcare reimbursement methods
Healthcare coding investigations
Documentation reviews
DRG

Full Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

A Licensed RN paired with a Coding Credential is the candidate this team is seeking for this position that will lead and oversee PI initiatives focused on potentially preventable readmissions, cost recovery, cost avoidance, and payment accuracy. You will lead a team focused on expanded readmission reviews allowing CNC to ensure payment accuracy as well as alignment with internal policies and regulatory requirements. Experience Required for all RN's with Coding Credentials applying:

5 + years of progressive experience in Payment Integrity, including readmission review and DRG validation activities, required.
3+ years of people leadership experience, including direct management of teams, required.
2+ or more years of experience using Diagnosis Related Group encoder and grouper tools (for example, 3M, Optum Encoder, TruCode, TruBridge, WebSTRAT, Payment Systems Incorporated, or similar tools), required.

Position Purpose:
Manages a team of auditors and clinical professionals and is accountable for audit quality, consistency, and overall program performance for potentially preventable readmissions. Oversees payer readmission review programs to ensure accurate, compliant determinations and achievement of payment integrity objectives. This role directs the identification and validation of potentially preventable readmissions while supporting appropriate reimbursement under MS-DRG and APR-DRG methodologies. Responsible for driving program results through audit oversight, trend analysis, and the development of standardized review criteria and best practices.

Lead and oversee Payment Integrity initiatives focused on potentially preventable readmissions, cost recovery, cost avoidance, and payment accuracy, ensuring alignment with established objectives, internal policies, and regulatory requirements.
Collaborate with Health Plans, Medical Economics, Finance, Compliance, Legal, Provider Relations, and Technology teams to support the design, execution, and ongoing monitoring of readmission and DRG-related Payment Integrity strategies.
Monitor program performance against defined metrics, financial targets, and operational benchmarks, using trend analysis to identify risks, variances, and opportunities for improvement.
Provide leadership and operational oversight to teams performing readmission, MS-DRG, and APR-DRG reviews, ensuring accuracy, consistency, timeliness, and adherence to established review standards.
Ensure compliance with federal and state regulations, managed care organization requirements, contractual obligations, and internal policies governing Payment Integrity and audit activities.
Prepare and present reports, analyses, and performance summaries to leadership and key stakeholders, highlighting audit outcomes, trends, and actionable recommendations.
Identify process gaps, operational risks, and control weaknesses, and implement or recommend corrective actions to improve quality, efficiency, and program effectiveness.
Lead, coach, and develop team members by setting clear expectations, promoting accountability, and fostering a culture of collaboration, quality, and continuous improvement.
Serve as a subject matter expert for Payment Integrity practices within assigned scope, providing guidance on readmission review methodology, audit standards, and reimbursement considerations.
Performs other duties as assigned.
Complies with all policies and standards.

Education/Experience:

Bachelor’s degree in Healthcare Administration, Business, Public Health, Health Information Management, Nursing, or a related field required; an additional four (4) years of directly related experience may be considered in lieu of a degree.

5 + years of progressive experience in Payment Integrity, including readmission review and DRG validation activities, required.
3+ years of people leadership experience, including direct management of teams, required.
2+ or more years of experience using Diagnosis Related Group encoder and grouper tools (for example, 3M, Optum Encoder, TruCode, TruBridge, WebSTRAT, Payment Systems Incorporated, or similar tools), required.
Experience working with payer claims systems preferred.
Demonstrated experience supporting government programs, regulatory compliance, or audit activities preferred.
Project management experience preferred.
Experience partnering with external vendors supporting Payment Integrity audit, recovery, or edit programs preferred.
Inpatient hospital documentation improvement experience preferred.

Master’s degree preferred.

License/Certification: Active Health Information Management or coding credentials required, such as RHIT, RHIA, CCS, CIC, or CCDS or Registered Nurse licensure or higher clinical qualification, in combination with a coding credential, required.

Pay Range: $87,700.00 - $157,800.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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Refine Your Search

claims supervisor jobs in vermont

RN Readmission Manager, Payment Integrity

Client Experience Manager, Pharmacy Benefits Management

Administration Manager

Senior Claim Supervisor

Safety Manager

Case Manager, Registered Nurse

Benefits Manager

Safety & Health Manager

Manager, Medical Economics

Manager, Actuarial Services

Sr. Manager, AI Lead - Semantic Layer - Remote

People & Culture Manager

Area Manager

Case Manager - Washington and Orange counties

RN Case Manager/Care Coordinator

Controller / Human Resources Manager

Case Manager -Addison County, Vermont

MDF Manager

Senior Project Manager - Highway Engineering - Burlington, VT

Pharmacy Operations Manager

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