Supervisor, Coding & Claims Resolution Analysts

About the role

The Supervisor of the Coding Analysts and Claim Resolution Analysts within Operations is responsible for the Coding and Claim Teams, and providing oversight and management of issue resolution for Medica’s members and providers across all business/products. The Coding Analysts and Claim Resolution Analysts support the timely resolution of issues received from Medica’s Customer Service (members/providers – all products) and issues received directly from Medica’s key providers and leased provider networks. The supervisor is responsible for managing the team’s performance and meeting our customers’ expectations for turn-around-time. The supervisor works toward root cause analysis by partnering with internal and external (vendor) partners. The supervisor supports internal customers and works with both internal and external vendor partners. Performs other duties as assigned.

Responsibilities

• Problem Solving, Escalated Issue Management, Relationship Management and Issue Resolution
• Leverages knowledge of all Medica products, policies and processes.
• Accurately interprets member and provider contracts and follows Medica’s procedures.
• Identifies processing errors or claim payment trends, accurately identifies the source and root cause of problems.
• Identifies inappropriate coding trends, claim processing trends, and system set up issues that result