Claims Program Manager – Spinnaker

About the role

The Claims Manager – Partner Programs is responsible for overseeing and managing assigned programs and Third-Party Administrators (TPAs). This role ensures claims are handled in accordance with established guidelines, regulatory requirements, and service expectations while supporting strong claim outcomes and partner relationships.

Responsibilities

• Oversee claims handling for assigned programs to ensure compliance with claims guidelines, coverage intent, and regulatory requirements
• Maintain close monitoring of TPA performance including timeliness, reserving accuracy, and overall claim quality
• Conduct file reviews and QA audits to identify trends and improvement opportunities
• Aid in the implementation and maintenance of claims guidelines and best practices
• Support onboarding of new programs including TPA setup, workflows, and reporting requirements
• Provide operational support and reporting, analyzing claims data and KPIs to identify emerging trends and performance issues
• Prepare stewardship and performance reports for internal stakeholders and program partners
• Track and follow up on corrective action plans
• Aid in reinsurance reporting and documentation requirements
• Support regulatory audits, data calls, and compliance reviews
• Serve as a primary point of contact for TPAs on routine matters
• Collaborate with underwriting, actuarial, finance, and legal teams
• Participate in program-level meetings and continuous improvement initiatives

Requirements

• 5–8 years of claims handling or program oversight experience
• Experience working with TPAs, MGAs, or delegated authority programs preferred
• Strong understanding of claims fundamentals
• Familiarity with multi-state regulatory environments
• Strong analytical, organizational, and communication skills
• Proficiency in Microsoft Excel and claims systems

Qualifications

• Nice to have: Experience in program business or fronting carrier environment, exposure to reinsurance reporting, industry designations such as AIC, CPCU, or ARM

Skills

• Build expertise in coverage analysis, reserving, litigation management, and regulatory compliance
• Support senior team members on complex claims
• Participate in training and development opportunities

Benefits and Perks

• Healthy Hippos Benefits - Multiple medical plans, 100% employer-covered dental & vision plans, retirement plan, short & long-term disability, employer-paid life insurance, FSA for health and dependent care, EAP
• Equity - Eligible for equity compensation
• Training and Career Growth - Training and internal career growth opportunities
• Flexible Time Off - Recharge when you need to
• Little Hippos Program - 12 weeks of parental leave for primary and secondary caregivers
• Hippo Habitat - Snacks and drinks available for onsite employees

Pay

The Morristown, NJ base pay range for this role is $120,000 - $150,250. Exact compensation may vary based on several job-related factors that are unique to each candidate, including but not limited to: skill set, experience, education/training, location, business needs and market demands.

Schedule

Not specified