Supervisor, Claims Operations

Supervisor, Claims OperationsMedica 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 ResponsibilitiesProvide daily leadership and direction for a team of claims operations employeesAssign and monitor work to ensure productivity, quality, and service expectations are metConduct regular one-on-one meetings and provide ongoing coaching, feedback, and development supportManage employee timecards, scheduling, attendance, and time-off requestsMonitor individual and team performance and address workflow, proficiency, quality, or performance concernsPromote employee engagement, collaboration, accountability, and an inclusive work environmentSupport hiring, onboarding, training, staffing, and performance management activitiesEnsure compliance with company policies, employment requirements, confidentiality standards, and applicable HR programsReview and approve claims that exceed processor authority based on established approval thresholdsMonitor daily claim receipts, inventory, and workflows to support service-level and timeliness expectationsAssist employees with escalated or complex claim issuesPromote consistent and accurate claim adjudication across multiple lines of businessAnalyze claim trends and escalate discrepancies, anomalies, or potential risks to leadershipMonitor incoming electronic data interchange volumes and clearinghouse performanceSupport daily reporting, tracking, and work distribution activitiesPrepare and complete operational reports used to monitor productivity, quality, and internal controlsLead claim payment reconciliation activities and authorize payment filesInvestigate and resolve reconciliation discrepanciesMonitor key operational metrics and recommend appropriate follow-up actionsServe as a claims operations subject matter resource for employees and business partnersRecommend process improvements that increase efficiency, strengthen accuracy, and reduce per-claim costsParticipate in cross-functional meetings and provide claims operations expertiseMentor and train new employees during onboarding and ongoing developmentProvide technical guidance that supports operational consistencyServe as a proxy for the Claims Manager when needed, including overseeing daily operations and participating in meetings and projectsMake day-to-day decisions within established guidelines, processes, and proceduresAssign work, monitor execution, and escalate complex issues when appropriateAdjust workflows and processes to support departmental objectivesProvide input regarding hiring, staffing, scheduling, and performance managementRemain accountable for team execution, work quality, service standards, and operational resultsRequired QualificationsHigh school diploma or equivalentThree years of relevant professional experiencePreferred QualificationsPrevious experience in a formal leadership, supervisory, or people-management roleDemonstrated ability to manage priorities and make decisions in a fast-paced operational environmentStrong verbal and written communication skillsHealthcare, health insurance, or medical claims experienceExperience with HealthRules Payor or a similar claims processing platformStrong coaching, conflict-resolution, and relationship-management skillsAbility to effectively manage different personalities and working stylesExperience using operational metrics to monitor performance and identify improvement opportunitiesThis 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.Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.