Claims & Payment Analytics Manager

Medica; Hopkins (MN); On-site; USD 79,000 - 135,000; Full time

Job summary

Medica is a nonprofit health plan seeking a Manager, Coding to lead Payment Analytics and Reimbursement Policy. The role includes oversight of audits, reporting to senior leadership, and driving improvements in claim payment accuracy and cost containment.

The position involves mentoring staff, collaborating with vendor management, SIU, and operations to reduce overpayments and implement robust pre-payment controls. Office-based role with onsite presence.

Qualifications

• Bachelor's degree or equivalent experience in related field.
• 7+ years progressive experience in claims and coding beyond degree.
• 5+ years of people leadership in healthcare operations.

Responsibilities

• Develop an executive reporting package for monitoring savings, trends and financial impact.
• Oversee day-to-day processes used by analysts for monthly savings efforts and recoveries.
• Identify root causes, influence stakeholders and sponsor process improvements to reduce waste and errors.
• Maintain relationships with Medica’s claim processing vendor to enhance policy management and reduce adjustments.
• Ensure processes are auditable and aligned with corporate policies and regulatory guidelines.
• Mentor staff, provide coaching, and conduct annual performance reviews.

Skills

7+ years of progressive claims and cod

5+ years people leadership in healthca

Analytical thinking

Cross-functional collaboration

Strategic thinking

Education

Bachelor's degree or equivalent experience in related field

Job description

Medica is a nonprofit health plan seeking a Manager, Coding to lead Payment Analytics and Reimbursement Policy. The role includes oversight of audits, reporting to senior leadership, and driving improvements in claim payment accuracy and cost containment.

The position involves mentoring staff, collaborating with vendor management, SIU, and operations to reduce overpayments and implement robust pre-payment controls. Office-based role with onsite presence.