Supervisor, Coding & Claims Resolution Analysts

About the role

Medica is a nonprofit health plan with more than a million members serving 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. Our team owns its work with accountability, makes data‑driven decisions, embraces continuous learning, and celebrates collaboration. The Supervisor of the Coding Analysts and Claim Resolution Analysts within Operations oversees the Coding and Claim Teams, providing oversight and management of issue resolution for Medica’s members and providers across all business/products. The role supports timely resolution of issues received from Medica’s Customer Service (members/providers – all products) and directly from key providers and leased provider networks.

Responsibilities

• Manage team performance and meet turn‑around‑time expectations.
• Conduct root cause analysis by partnering with internal and external (vendor) partners.
• Supervise staff: set objectives, coach and develop, provide feedback, conduct annual performance reviews.
• Hold regular staff meetings/huddles and 1:1 meetings.
• Manage staffing, training, scheduling, and team morale.
• Promote a positive working climate that supports open communication, integrity, service quality, innovation, and achievement focus.
• Hold staff accountable for meeting department standards and formulate action plans for sub‑standard performance.
• Identify processing errors or claim payment trends, determine source and root cause.
• Identify inappropriate coding trends, claim processing trends, and system setup issues that result in errors; engage appropriate parties to develop resolution plans.
• Analyze complex operational issues, review provider contracts, files, systems, policies and procedures to formulate a clear picture, identify causes and effects.
• Proactively communicate with providers, members, and internal customers within appropriate time frames; document all provider and other applicable issues in the ePIL database following established business rules.
• Utilize software applications needed to research and resolve claim issues (IDRS, ISET, Info Reports, COSMOS, Health Rules, etc.).
• Contact and coordinate resources (other departments, vendor partners, providers) to resolve identified operational issues effectively and timely.
• Coordinate data from provider, Siebel/Oracle reports, and customized reports to identify accurate data for claims projects.
• Monitor claims project status, communicate progress to stakeholders (providers, network management, upper management, customer service operations, etc.).
• Document project status and resolution in ePIL as required.
• Effectively manage many projects simultaneously; plan and execute special projects as requested by management.
• Assist with companywide initiatives or changes.
• Lead communication to key strategic providers.

Qualifications

• Bachelor's degree or equivalent experience in a related field.
• 5+ years of work experience beyond degree in coding.
• 1+ years of coding team leadership experience.
• Prior claims operations experience in a health plan setting (preferred).
• Demonstrated problem‑solving skills including root cause analysis (preferred).
• Ability to collaborate effectively with cross‑functional partners, including external partners (preferred).

Skills

• Problem solving and escalated issue management.
• Relationship management and issue resolution.
• Knowledge of all Medica products,