Claims Manager, TPA Oversight

About the Role

Provide oversight of Specialty Claims Third Party Administrators (TPAs) managing casualty, property, inland marine, excess/umbrella, and professional liability claims. Responsibilities include leadership of TPA oversight adjusters, high-exposure case management, participation in TPA selection, audits and reviews, and assistance with onboarding and setup of new TPAs.

Responsibilities

• Oversee the performance of TPA operations to ensure adherence to service level agreements and claim handling guidelines.
• Assist with the negotiation of services, contracts, and service level agreements for TPAs.
• Conduct regular audits of TPA Operations to ensure compliance with company standards and regulatory requirements.
• Review and approve authority levels for claims settlements, ensuring they are in line with company policies.
• Serve as the primary point of contact for assigned TPAs, fostering strong relationships and effective communication.
• Analyze claims data to identify trends, areas of risk, and opportunities for cost savings.
• Provide technical guidance on complex claims and support TPAs in the resolution of high-exposure cases.
• Manage key relationships with leadership at TPAs to ensure claims are being handled in line with service level agreements and quality expectations.
• Lead business review meetings to discuss performance metrics, areas for improvement, and strategic planning.
• Oversee claims adjusters assigned to handle TPA escalations and day-to-day oversight.
• Ensure compliance with all local, federal, and state regulations related to claims while minimizing risk/exposure to the organization.
• Participate in underwriting, actuarial, client, or broker meetings regularly.
• Demonstrate knowledge of severity files and trends.
• Provide reserve and settlement authority to claim staff in connection with their requests and recommendations.
• Build and develop organizational talent.
• Other duties as assigned.

Requirements

• A Bachelor’s degree or the equivalent education and/or experience.
• 8+ years of progressive claims management and TPA oversight experience.
• Adjuster licenses, as mandated by specific states, are required.
• Experience managing a team.

Skills & Competencies

• Proven track record of effectively managing TPAs and improving claims handling processes.
• Claims operations experience with the ability to drive process and best practices.
• Comprehensive understanding of claims, litigation, and trial process.
• Strong business and financial acumen, including negotiation skills, data analysis, critical thinking, business analysis, and organizational skills.
• Deep knowledge of coverage analysis, multi-jurisdictional compliance, and claims management platforms.
• High level of emotional intelligence, influencing skills, and communication skills to enable collaboration with a variety of key stakeholders including senior executive stakeholders.
• Excellent verbal and written communication skills.
• Proven ability in the use of metrics and data to drive performance, ensure continuous improvement, and increase efficiency.
• Broad-based claims knowledge across multiple specialty lines.
• Experience in excess/umbrella, Property, D&O/E&O claims, and/or general liability.
• Ability to travel as needed.

Benefits

• Medical, dental, life, and vision insurance.
• Company-paid short/long term disability.
• 401(k) retirement plan.
• Tuition assistance.