Supervisor, Claims Operations

Medica is a nonprofit health plan serving more than a million members across Minnesota, Nebraska, Wisconsin, Missouri, and beyond. The organization delivers personalized health‑care experiences, partners closely with providers, and fosters a collaborative, data‑driven culture where success is a team sport.

About the Role

The Supervisor, Claims Operations provides day‑to‑day leadership for a team that supports the timely and accurate adjudication of medical claims across multiple lines of business. Responsibilities include assigning and monitoring work, coaching employees, managing performance, ensuring operational, quality, and service standards, serving as a claims subject‑matter resource, supporting reporting and reconciliation, and identifying opportunities to improve efficiency and accuracy.

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; 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 thresholds.
  • Monitor daily claim receipts, inventory, and workflows to meet 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 & 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.
  • Act as a proxy for the Claims Manager when needed, overseeing daily operations and participating in meetings and projects.
• Scope & 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.

Compensation

The full salary grade for this position is $50,800 – $87,000. The typical hiring range is $50,800 – $76,125, with placement dependent on education, experience, certifications, scope of responsibility, internal equity, and market data.

Benefits

• Competitive medical, dental, and vision coverage.
• Paid time off and holidays.
• Paid volunteer time off.
• 401(k) contributions.
• Caregiver services.
• Additional total‑rewards offerings to support employee well‑being.

Work Schedule & Location

This is an office‑based role requiring on‑site work an average of three days per week. Candidates should be located near one of the following offices: Minnetonka, MN, or Madison, WI.

Eligibility

Applicants must be legally authorized to work in the United States at the time of application. Medica does not sponsor work visas for this role.