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High-cost claim navigator
Our solution proactively combines clinical and financial oversight to identify high-cost claims early, close care gaps, reduce medical and pharmacy spending, and optimize carrier performance.
Turn high-cost claims into strategic savings with our clinical high-cost claimant oversight solution
As employers look ahead to 2027, the biggest benefits budget risk is high‑cost claims. Most reviews are still retroactive (quarterly or annual) and focused mainly on clinical management — often missing early warning signs and the financial drivers that shape what the claim will ultimately cost. Our differentiating approach is proactive, ongoing monitoring that pairs clinical oversight with financial oversight so you can identify issues sooner, intervene faster, and ensure you’re paying the right price on the ~1% of claimants driving ~1/3 of spend.
High-cost claim (HCC) navigator’s management cycle is prospective — it’s engaged, on-going, and ultimately feeds back into plan strategy.
Across 300+ clients, our ongoing monitoring flagged over 700 claims. Beyond identifying clinical opportunities, in certain cases we delivered financial savings ranging from five figures to multi-million dollars.
High-cost claim (HCC) navigator’s management cycle is prospective — it’s engaged, on-going, and ultimately feeds back into plan strategy.
Across 300+ clients, our ongoing monitoring flagged over 700 claims. Beyond identifying clinical opportunities, in certain cases we delivered financial savings ranging from five figures to multi-million dollars.
Common opportunities:
- Close care gaps
- Drive cost savings for both medical and pharmacy
- Gain actionable insights
- Optimize carrier performance
“As healthcare costs in the US continue to rise, we rely on experts like to help ensure our medical services are delivered in the most optimal manner. Following a recent review, the Marsh clinical team successfully identified and redirected a few high-cost infusion claims from a hospital-based center to a lower-cost facility offering the same level of care. This proactive intervention is expected to save us over $200,000 annually.
We are grateful for Marsh’s expertise and dedication in helping us manage healthcare costs while maintaining quality care for our members.”
Senior Director, Global Benefits Software company with 15,000 US employees
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