Analyze financial data by collecting, monitoring and creating financial models for decision support. Improve financial status by analyzing results; monitoring variances; identifying trends; recommending actions to management. Assist with annual and quarterly forecasting. Performs other duties as assigned.
POSITION SUMMARYLead medical expense month-end close for Fully-Insured Medica Legacy business, including claims and accrual accuracy, COB Rawlings recoveries, Plan-to-Plan and MDP/CGDP processing, Medicare Cost reporting, and Medicaid Legacy quarterly data submissions. This role requires strong analytical skills, attention to detail, and the ability to manage complex financial processes while leading and developing team members.
ESSENTIAL DUTIES AND RESPONSIBILITIES Claims & Medical Expense Management • Monitor weekly claims cycles and trends to identify variances and ensure timely processing
• Prepare and post month-end journal entries for claims activity, including paid claims, interest, IBNR, and claim reserves
• Reconcile and clear claims clearing account monthly; investigate and resolve timing or system-related
• Develop, review, and validate IBNR estimates and claim reserves for month-end close
• Reconcile medical expense movements to actuarial projections; analyze and explain variances
Financial Close & Reporting • Retrieve CMS Plan-to-Plan files, review payment calculations, ensure attestations are completed
• Record resulting receivables/payables and cash impacts in the GL
• Process Manufacturer Discount Program (MDP) and CGDP payments, projections, and accruals
• Create intercompany payables
• Maintain appropriate reserves for vendor payments
• Adjust non-claims expenses for invalid Product/Unit/DOS/Location combinations
Regulatory Compliance & Filings • Support DHS Data Request preparation and MLR Filing submissions
• Support Medicare Cost Report preparation including Annual Filing, Interim Cost Reports, Budget and Preliminary Models
• Provide audit support and analytics
• Prepare Reconciliation to Actuarial Triangles, Redundancy Schedules, Claims Rollforward, and Medical Expense
Systems & Process Improvement • Provide subject-matter expertise for GL migration activities including requirements clarification, data validation, parallel testing, and reconciliation of legacy vs new GL outputs
• Support platform migration initiatives including testing and issue resolution
• Promote financial data enhancements and resolve system-related issues
Leadership & Team Development • Conduct regular one-on-one meetings for team leadership and coaching
Participate in team meetings, leadership forums, and organizational events
Required Qualifications- Bachelor's degree in related field or equivalent experience
- 6 years of experience
- Prior supervision experience
This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI.
The full salary grade for this position is $100,300 - $172,000. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $100,300 - $150,465. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.
The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.
