Supervisor, Claims Operations

Medica•Minnetonka, MN

4d•Hybrid

About The Position

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.

Requirements

High school diploma or equivalent
Three years of relevant professional experience

Nice To Haves

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

Responsibilities

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
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
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
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
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