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Complex Claims Director Jobs in Minnesota (NOW HIRING)

Medica

Director, Claims Operations

Minnetonka, MN · On-site

$113K - $194K/yr

The Director, Claims Operations oversees end-to-end claims functions, including claims processing ... Ability to manage people and process in a highly matrixed and complex organization an Office role ...

Imedica

Director, Claims Operations

Minnetonka, MN · On-site

$113K - $194K/yr

The Director, Claims Operations oversees end-to-end claims functions, including claims processing ... Ability to manage people and process in a highly matrixed and complex organization an Office role ...

Allianz

APH Claims Adjuster III | Remote

Minneapolis, MN · On-site +1

Manage a caseload of complex asbestos accounts. * Timely claim management of new loss assignments ... This position will report to the Director of Asbestos Claims. This position may require occasional ...

Trean Corporation

Senior Claims Adjuster

Wayzata, MN · On-site

$75K - $90K/yr

POSITION SUMMARY: The Senior Claims Adjuster is responsible for managing complex workers ... Direct claims assistants to facilitate adjuster assignments as required. This includes directing ...

Corvel

Indemnity Claims Specialist

Minneapolis, MN · Remote

$51K - $83K/yr

... complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the ...

Corvel

Indemnity Claims Specialist

Minneapolis, MN · On-site

$51K - $83K/yr

... complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the ...

Liberty Mutual

Senior Claims Specialist

Saint Paul, MN

$79K - $129K/yr

... complex, highexposure property claims with minimal supervision. In this role, you take ownership of ... direct policyholder interaction when additional expertise is needed. This position is ideal for ...

Liberty Mutual

Senior Claims Specialist

Minneapolis, MN

$129K/yr

... complex, high-exposure property claims with minimal supervision. In this role, you take ownership ... direct policyholder interaction when additional expertise is needed. This position is ideal for ...

TPAC Underwriters

Clinical Risk Nurse

Minneapolis, MN · On-site

$90K - $120K/yr

... directed by leadership * Partner with Third-Party Administrators (TPAs), brokers, and other stakeholders to proactively manage large and complex claims, identify risk mitigation strategies, and ...

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Complex Claims Director information

What is the difference between Complex Claims Director vs Claims Manager?

AspectComplex Claims DirectorClaims Manager
CredentialsTypically requires a professional insurance certification (e.g., CPCU, ARM) and extensive industry experienceOften requires relevant insurance licenses and several years of claims handling experience
Work EnvironmentStrategic leadership in large insurance companies or third-party administrators, overseeing complex claimsDay-to-day claims processing and team supervision within insurance companies or agencies
Employer & Industry UsageCommonly found in large insurers, TPA firms, and corporate risk managementWidely used across insurance carriers, agencies, and claims departments

The Complex Claims Director focuses on managing and overseeing complex, high-value claims and strategic claims operations, often at a senior level. In contrast, Claims Managers handle daily claims processing, team supervision, and operational tasks. Both roles require industry-specific credentials, but the Director position emphasizes strategic oversight of complex cases.

How does a complex claims director typically collaborate with legal teams and other departments during high-stakes claims investigations?

As a Complex Claims Director, collaboration with legal teams and other departments such as underwriting, risk management, and compliance is a central part of the role. Directors often lead cross-functional meetings to share critical case updates, discuss strategies for claim resolution, and ensure all regulatory and contractual requirements are met. Effective communication and coordination are essential, as these cases may involve litigation, negotiations, and extensive documentation. Building strong relationships across departments helps streamline the process and achieve the best possible outcomes for both the client and the organization.

What are the key skills and qualifications needed to thrive as a complex claims director, and why are they important?

To thrive as a Complex Claims Director, you need deep expertise in insurance claims management, strong analytical abilities, and a relevant bachelor's degree or higher, often with industry certifications such as CPCU or AIC. Familiarity with claims management systems, regulatory compliance tools, and advanced reporting software is typically required. Exceptional leadership, negotiation, and decision-making skills help you manage teams and resolve high-stakes claims efficiently. These competencies are crucial for ensuring accurate claim resolution, minimizing risk, and maintaining client trust in complex insurance environments.

What is a complex claims director?

Complex Claims Directors are senior insurance professionals responsible for overseeing the management and resolution of intricate insurance claims, often involving large financial exposures, multiple parties, or complex legal issues. They lead a team of claims specialists, coordinate with legal counsel, and ensure that claims are handled efficiently and in compliance with company policies and regulations. Their expertise helps organizations mitigate risk and ensure fair outcomes for all parties involved.
What are popular job titles related to Complex Claims Director jobs in Minnesota? For Complex Claims Director jobs in Minnesota, the most frequently searched job titles are:
What job categories do people searching Complex Claims Director jobs in Minnesota look for? The top searched job categories for Complex Claims Director jobs in Minnesota are:
What cities in Minnesota are hiring for Complex Claims Director jobs? Cities in Minnesota with the most Complex Claims Director job openings:
Complex Claims Director jobs near you

Director, Claims Operations

Medica

Minnetonka, MN • On-site

$113K - $194K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 18 days ago

Medica rating

8.4

Company rating: 8.4 out of 10

Based on 22 frontline employees who took The Breakroom Quiz

116th of 303 rated insurance

Job description

Medica is a nonprofit health plan with more than a million members that serves 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.
We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.
The Director, Claims Operations oversees end-to-end claims functions, including claims processing, payment recovery, claim analysis and issue resolution, and provider appeals. A skilled people and operations leader, the Director, Claims Operations ensures high-quality, timely, and accurate service delivery for customers, members, and providers across all lines of business in a dynamic, growth-oriented environment. The role holds accountability for operational performance, cost management, and quality outcomes, while driving scalability and standardization to support geographic expansion and increasing complexity.
Key Accountabilities
  • Claims Operations Oversight

    • Design, implement, and continuously enhance controls and reporting across Claims Operations
    • Own MBRs and executive-level reporting, including ad hoc SLT requests
    • Provide end-to-end oversight of claims processing from intake through adjudication and payment
    • Own performance management across daily, monthly, and quarterly KPIs, ensuring controls and actions drive service, cost, productivity, and quality outcomes
    • Partner cross-functionally (Payment Integrity, Customer Service, EDI, Configuration, Finance, IT, Compliance/SIU, Markets) to ensure accurate, timely claims outcomes and alignment across a matrixed environment
    • Build and lead a high-performing organization, driving accountability, talent development, and engagement
    • Drive operational excellence through issue resolution, root cause analysis, and continuous improvement across processes, policies, and technology to prevent recurrence and optimize end-to-end performance

  • Strategic Planning

    • Continuously assess and optimize people, process, and technology to exceed key performance measures (e.g., accuracy, quality, timeliness)
    • Identify and prioritize improvement opportunities with clearly defined success metrics
    • Develop business cases for large-scale initiatives and oversee execution against budget, timelines, and interdependencies
    • Represent Claims Operations in governance forums and enterprise committees

  • Improvement and Implementation

    • Lead implementation of strategic initiatives across people, process, and technology
    • Execute changes supporting process improvements, new business integration, and measurable performance outcomes
    • Define and execute an optimized workforce strategy, including BPO partnerships, to drive cost efficiency and scalability

Required Qualifications
  • Bachelor's degree or equivalent experience in related field
  • 10+ years of work experience beyond degree in healthcare, health plans and/or claims operations
  • 5+ years of people leadership experience
  • Experience partnering cross-functionally (e.g., Payment Integrity, Finance, IT, Compliance) to deliver end-to-end claims outcomes
  • Strong track record of driving operational performance across service, cost, productivity, and quality metrics
  • Strong analytical and problem-solving capabilities with a focus on root cause analysis and continuous improvement

Preferred Qualifications
  • Experience with claims platform system migration in a build environment
  • Proved expertise in change management with the ability to lead through change
  • Ability to manage people and process in a highly matrixed and complex organization

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 $113,400 - $194,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $113,400 - $170,100. 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.
Internal Applicants: We're excited about your interest in growing your career at Medica! To be eligible to apply for internal opportunities, employees must have been in their current role for at least one year.
Recruiter: Stacey Manley
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.
We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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