Supervisor, Claims Operations

Job Description

Job Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

Medica's Supervisor, Claims Operations provides day-to-day leadership for a team responsible for supporting the timely and accurate adjudication of medical claims across multiple lines of business. This position assigns and monitors work, coaches employees, manages team performance, and ensures operational, quality, and service expectations are consistently met.

The Supervisor also serves as a claims subject matter resource, supports reporting and reconciliation activities, and identifies opportunities to improve operational efficiency and accuracy. Performs other duties as assigned.

Key Responsibilities

People Leadership

• Provide daily leadership and direction for a team of claims operations employees
• Assign and monitor work to ensure productivity, quality, and service expectations are met
• Conduct regular one-on-one meetings and provide ongoing coaching, feedback, and development support
• Manage employee timecards, scheduling, attendance, and time-off requests
• Monitor individual and team performance and address workflow, proficiency, quality, or performance concerns
• Promote employee engagement, collaboration, accountability, and an inclusive work environment
• Support hiring, onboarding, training, staffing, and performance management activities
• Ensure compliance with company policies, employment requirements, confidentiality standards, and applicable HR programs

Claims Operations

• Review and approve claims that exceed processor authority based on established approval thresholds
• Monitor daily claim receipts, inventory, and workflows to support service-level and timeliness expectations
• Assist employees with escalated or complex claim issues
• Promote consistent and accurate claim adjudication across multiple lines of business
• Analyze claim trends and escalate discrepancies, anomalies, or potential risks to leadership

Reporting, Monitoring, and Reconciliation

• Monitor incoming electronic data interchange volumes and clearinghouse performance
• Support daily reporting, tracking, and work distribution activities
• Prepare and complete operational reports used to monitor productivity, quality, and internal controls
• Lead claim payment reconciliation activities and authorize payment files
• Investigate and resolve reconciliation discrepancies
• Monitor key operational metrics and recommend appropriate follow-up actions

Subject Matter Expertise and Process Improvement

• Serve as a claims operations subject matter resource for employees and business partners
• Recommend process improvements that increase efficiency, strengthen accuracy, and reduce per-claim costs
• Participate in cross-functional meetings and provide claims operations expertise
• Mentor and train new employees during onboarding and ongoing development
• Provide technical guidance that supports operational consistency
• Serve as a proxy for the Claims Manager when needed, including overseeing daily operations and participating in meetings and projects

Scope and Decision-Making

• Make day-to-day decisions within established guidelines, processes, and procedures
• Assign work, monitor execution, and escalate complex issues when appropriate
• Adjust workflows and processes to support departmental objectives
• Provide input regarding hiring, staffing, scheduling, and performance management
• Remain accountable for team execution, work quality, service standards, and operational results

Required Qualifications

• High school diploma or equivalent
• Three years of relevant professional experience

Preferred Qualifications

• Previous experience in a formal leadership, supervisory, or people-management role
• Demonstrated ability to manage priorities and make decisions in a fast-paced operational environment
• Strong verbal and written communication skills
• Healthcare, health insurance, or medical claims experience
• Experience with HealthRules Payor or a similar claims processing platform
• Strong coaching, conflict-resolution, and relationship-management skills
• Ability to effectively manage different personalities and working styles
• Experience using operational metrics to monitor performance and identify improvement opportunities

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI. 

The full salary grade for this position is $50,800 - $87,000. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $50,800 - $76,125. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.  In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.