About this opportunity
Medica lists this Supervisor, Claims Operations opportunity in madison, Wisconsin. Review the employer’s description below for duties, qualifications and application requirements.
Job description
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.
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.
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.