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Complex Claims Director Jobs in Minnesota (NOW HIRING)

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Complex Claims Director information

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.

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 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.

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-Payor Provider Payments Analytics - Revo Health

Revo Health

Bloomington, MN • On-site

$130K - $201K/yr

Full-time

Medical, Dental, Vision, Retirement

Posted 25 days ago

Job description

The Director of Payor/Provider Payments & Analytics is a strategic and hands-on leader responsible for overseeing payment analytics, reconciliation, and financial performance reporting across all payor contracts for a growing independent physician group. This role requires a unique blend of technical expertise (SQL, data modeling), operational leadership, and the ability to translate complex financial data into clear, actionable insights for physicians and executive stakeholders.

This role is critical to unlocking financial performance and transparency across the organization. By combining rigorous analytics with strong physician engagement, the Director will directly influence reimbursement optimization, provider satisfaction, and long-term sustainability in an evolving healthcare landscape.

The ideal candidate thrives at the intersection of finance, analytics, and healthcare operations—bringing rigor to data while effectively “telling the story” behind performance trends to drive clinical and financial decision-making.

This is a full-time role working standard business hours. Opportunity for hybrid, out of Bloomington.

Revo Health is a professional services company that partners with multiple healthcare groups to deliver exceptional patient care. This position will be employed by Revo Health, working closely with Infinite Health Collaborative (i-Health) and its operating divisions.

 

Essential Job Functions:

Leadership & Strategy

  • Lead and develop a high-performing team responsible for payor analytics, provider compensation support, payment integrity, and credentialing
  • Serve as a strategic partner to executive leadership and physicians on financial performance, reimbursement trends, and contract optimization
  • Define and execute analytics strategy aligned with organizational growth, value-based care initiatives, and contracting priorities
  • Establish best practices, controls, and scalable processes for data governance and reporting

Payor & Provider Payment Analytics

  • Oversee analysis of payor reimbursement, contract performance, and payment variance (expected vs. actual)
  • Lead initiatives to improve revenue capture, identify leakage, and enhance payment accuracy
  • Partner with revenue cycle and contracting teams to evaluate payor agreements and model financial impact
  • Support provider compensation models with accurate, transparent data and insights

Technical Analytics & Data Management

  • Serve as a hands-on leader in data extraction, transformation, and analysis using SQL and related tools
  • Design and oversee data models, reporting frameworks, and dashboards (e.g., Power BI, Tableau, or equivalent)
  • Ensure data integrity across multiple systems (EHR, billing, payor feeds, financial systems)
  • Translate business questions into data requirements and analytical outputs

Physician Engagement

  • Present complex financial and operational data to physicians in a clear, concise, and compelling manner
  • Develop intuitive dashboards and visualizations that enable physician leaders to understand key drivers of performance
  • Act as a bridge between technical teams and clinical stakeholders, ensuring insights are actionable and relevant
  • Facilitate discussions with physician leadership on productivity, reimbursement trends, and improvement opportunities
  • Work independently with minimal supervision.
  • Other duties as assigned.

Education and Experience:

Required

  •  Bachelor’s degree in Healthcare Administration, Data Analytics, Finance, or related field
  •  8–12+ years of experience in healthcare analytics, finance, or revenue cycle, with at least 3–5 years in a leadership role
  •  Advanced SQL skills (data extraction, joins, aggregations, performance tuning)
  •  Experience analyzing healthcare claims, reimbursement methodologies, and provider compensation
  •  Demonstrated ability to lead teams while remaining hands-on technically
  •  Strong communication and presentation skills, with experience working directly with physicians or clinical leaders

Preferred

  •  Experience in an independent physician group, MSO, or multi-specialty practice
  •  Familiarity with value-based care models, risk arrangements, and population health analytics
  •  Experience with BI tools (Power BI, Tableau) and data warehousing concepts
  •  Knowledge of CPT/HCPCS coding, fee schedules, and payor contract structures
  •  MBA, MHA, or related advanced degree
  • Strong analytical skills and experience in healthcare analytics.

Key Competencies

  •  Strategic thinker with operational execution
  •  Strong data storyteller—able to simplify complex analytics for non-technical audiences
  •  Technical depth—credible and capable in SQL and data architecture discussions
  •  Physician partnership mindset—collaborative, credible, and solution-oriented
  •  Continuous improvement focus—drives efficiency, accuracy, and scalability

Benefits & Compensation:

  • Actual starting pay will vary based on education, skills, and experience.
  • We offer a comprehensive benefits package - to learn more click here.
    • Employees working 30+ hours per week (60 hours per pay period) are eligible for our Medical (w/Maternity Bundle), Dental & Vision plans, as well as Tuition Reimbursement.
    • All employees, regardless of hours, are eligible for 401(k) Profit Sharing, Employee Assistance Program, Lifetime Fitness Subsidy, Car Rental discounts, Home, Auto, & Pet insurance savings programs & more.

Working Conditions:

  • Ability to sit for extended periods (up to 8 or more hours per day).
  • Frequent use of hands and fingers for typing, writing, and handling documents.
  • Occasional standing, walking, bending, or reaching within the office environment.
  • Ability to lift and carry office supplies or files weighing up to 20 pounds.
  • Visual acuity to read electronic and paper documents.
  • Auditory ability to participate in phone or video calls clearly.
  • Manual dexterity to operate standard office equipment (e.g., computer, phone, printer).

Essential Requirements: 

Ability to: 

  • Comply with company policies, procedures, practices, and business ethics guidelines. 
  • Comply with all applicable laws and regulations, (e.g. HIPAA, Stark, OSHA, employment laws, etc.) 
  • Demonstrate prompt and reliable attendance. 
  • Work at an efficient and productive pace, handle interruptions appropriately, and meet deadlines. Prioritize workload effectively.
  • Communicate respectfully and professionally in face-to-face, phone and email interactions. Apply principles of logical thinking to define problems, establish facts, and draw valid conclusions.  

Notes 

  • Revo/ i-Health is an Equal Opportunity Employer. We are committed to fostering an inclusive and accessible workplace. Reasonable accommodation may be provided to enable individuals with disabilities to perform essential job functions. Applicants or employees who wish to request an accommodation may do so by emailing HR@RevoHealth.com. For more information, please review the Know Your Rights notice from the U.S. Equal Employment Opportunity Commission.
  • We participate in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: https://www.e-verify.gov/employees/employee-rights-and-responsibilities
  • Please note: This job description is intended to describe the general nature and level of work being performed by individuals assigned to this position. It is not an exhaustive list of all duties, responsibilities, and qualifications required. Revo/ i-Health reserves the right to modify job duties or descriptions at any time, with or without notice, in accordance with applicable laws.

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