Large Claimant Management
Supporting high-cost individuals
Care coordination and cost management for employees with catastrophic or complex health conditions
Why does large claimant management matter?
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A small number of individuals generate most healthcare costs. The top 5% of claimants typically account for 50%+ of claims. Managing these individuals effectively—improving their care while containing costs—has outsized impact on overall plan performance.
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See where your benefit plan is leaking
Find out what gaps exist — and what you can do without changing your plan.
We'll show you where money is leaking, risks are growing, and what you can fix within your current structure. No pressure to change brokers, carriers, or benefit design. Just clarity.
- Gap analysis based on your actual plan structure
- Clear findings you can share with your broker
- Recommendations that layer on — no disruption required
Care Coordination
Ensuring large claimants receive coordinated, appropriate care. Better coordination often reduces costs while improving outcomes.
Cost Containment
Identifying opportunities to reduce costs without compromising care: alternative treatments, facility selection, billing accuracy.
Stop-Loss Coordination
Managing the interface between plan and stop-loss carrier, ensuring appropriate reimbursement for covered claims.
Ongoing Monitoring
Tracking large claimants over time, anticipating needs, and managing continuing exposure.
What is Large Claimant Management?
Large Claimant Management provides focused attention on individuals with catastrophic or complex health conditions who generate significant healthcare costs.
These individuals need support—complex conditions require coordination, navigation, and advocacy. Proper management improves their care and experience.
Simultaneously, focused attention identifies cost containment opportunities that don't exist with routine claims: alternative treatments, center of excellence options, billing error correction, and care optimization.
Why Do Large Claims Require Special Attention?
Most employers renew their health plans year after year without questioning the underlying assumptions. Brokers present options, carriers set rates, and leadership approves budgets based on incomplete information.
The result? Companies overpay for benefits employees don't use while missing coverage gaps that create real risk. They accept premium increases as inevitable rather than addressable. They lack visibility into where their money actually goes.
A Healthcare Risk Assessment changes that. It gives you the data and insight to make informed decisions, negotiate from a position of strength, and take control of one of your largest operating expenses.
How It Works
Large claimant management provides focused support for high-cost individuals.
Identification
Identifying large claimants through claims monitoring, stop-loss notifications, and care team reports.
Assessment
Assessing the individual's situation: condition, treatment plan, care coordination needs, and cost containment opportunities.
Intervention
Implementing appropriate interventions: care coordination, provider selection, treatment optimization, billing review.
Ongoing Management
Continuing to monitor and support the individual throughout their care journey.
When Do Large Claims Require Management?
Management is triggered by:
• Claims approaching or exceeding stop-loss thresholds
• Complex diagnoses requiring coordinated care
• Hospitalizations for serious conditions
• Chronic conditions with escalating costs
• Any situation generating significant claims
Where Does Large Claimant Management Occur?
Management occurs wherever the individual receives care:
• Hospital care coordination
• Outpatient treatment optimization
• Pharmacy management for high-cost medications
• Post-acute care transitions
• Ongoing chronic disease management
Who Benefits from Large Claimant Management?
Both individuals and plans benefit:
• Patients receive better coordinated care
• Complex conditions are navigated more effectively
• Plans achieve cost containment
• Stop-loss recoveries are maximized
• Overall plan performance improves
See What Our Customers Are Saying
"What could have been data driven, was soon a conversation. Over 3 years with the best coaches, listeners, advisors you could ask for. If Monique didn't have an answer readily, she would note it, research it, and then update you on the answer. Always a positive meeting. Highly recommend!"
— Sue D.
“Our Medical Insurance Premiums were Out of Control! Thanks to Weltrio and their amazing team of healthcare experts, Weltrio is my single most-profitable cost center!”
— Cayuse CEO
Everything You Need to Know
At Weltrio, we are a medically trained team that works with HR and benefits partners at companies of all sizes to improve healthcare quality, reduce risk exposure, and optimize costs. We work within your existing plan structure—providing employers with clarity, trust, and transparency at every step. Whether you're upgrading your benefits plan or building from scratch, we've got you covered.
Is this the same as telemedicine?
No. Clinical support provides guidance and triage, not diagnosis or treatment. We help employees decide when and where to seek care.How many nurses will be assigned to our company?
Assignment depends on your company size and typical utilization. Smaller companies may share a primary nurse with backup coverage. Larger organizations get dedicated teams. Either way, employees experience consistent relationships with clinical professionals who know them.Who answers calls in the middle of the night?
Board-certified nurses from your Weltrio clinical team. We staff night shifts with experienced nurses who have full access to your company's benefits information and employee interaction history. It's not an outsourced answering service.What protocols do nurses use for triage?
Our nurses use evidence-based clinical decision support protocols developed from emergency medicine and primary care best practices. These protocols are regularly updated based on current medical guidelines and are customized for telephone/virtual assessment settings.How much does an unnecessary ER visit actually cost?
Average ER visits cost $2,200 or more—even for minor issues. Add lab work, imaging, or specialist consultation and costs climb quickly. The same conditions treated at urgent care typically cost $150-300, and telehealth visits run $50-75.
