Senior Manager, Claims (Sports & Fitness Insurance)

Responsibilities

• Evaluate and provide proposed changes to the claims operating model — workflows, TPA relationships, technology, and vendor mix, identifying and surfacing gaps, as well as recommending improvements.
• Contribute to build-vs-buy conversations, partnering with leadership to make decisions on claims technology, staffing, and outsourced services, and help define and track success metrics.
• Build and maintain the playbook and standards for how claims get handled, audited, and improved as the function grows – creating a best-in-class claims experience.
• Maintain oversight of commercial claims, including complex and litigated matters — validating coverage, liability, reserves, and settlement strategy, and directing TPAs, adjusters, and counsel.
• Own the file audit and QC process: monitor SLAs, cycle times, litigation rates, and recovery performance, and develop remediation plans where standards slip.
• Support internal and external audits, and MGA financial/regulatory reporting — carrier-specific and state-required submissions, surplus lines, and related compliance obligations.
• Analyze claim outcomes across TPAs, jurisdictions, and programs to surface process and underwriting insights, and recommend improvements based on data.
• Serve as the primary point of contact for TPA relationships, submitting GL and A&H claims, coordinating loss run requests, and escalating issues to drive resolution.
• Partner closely with Athlete Safety, providing claims data, loss trends, and risk insights that directly inform prevention and education efforts — helping improve our loss ratio and helping the organizations we insure manage risk more effectively.
• Lead data cleanup across MGA and claims systems, and support system migrations, broker onboarding, and platform, process and workflow optimization as Players Health's tech stack matures.
• Build and maintain claims dashboards that track trends, performance, and program health, translating claims data into insights that inform underwriting and risk decisions.
• Own the day-to-day execution of the claims function, working autonomously in a remote environment while staying closely aligned with leadership on strategy and direction.
• Lay the groundwork for the future claims team - process documentation, standards, and onboarding structure - with the opportunity to lead and develop that team as it's built out.
• Set clear standards and workflows for anyone supporting the function - TPA partners today, and any future claims team members as the team grows.
• Model ownership, collaboration, and continuous improvement in support of organizational growth and mission alignment.
• Occasional travel for team engagement, collaboration, or events.

Qualifications

• 5+ years experience in commercial insurance or an MGA, with specific experience handling claims.
• Experience managing and/or supporting TPA relationships.
• Experience supporting and contributing to claims strategy and/or operating-model, and process decisions.
• Demonstrated experience evaluating or redesigning claims operating models, processes, or vendor structures.
• Experience working with TPAs, audits, and regulatory/carrier reporting.
• Strong analytical, organizational, and communication skills, with excellent interpersonal, negotiation, and conflict-resolution ability.
• Proven ability to manage time and meet deadlines while working autonomously in a remote environment.
• Ability to act with integrity, professionalism, and confidentiality.
• Baseline digital literacy: proficient with Microsoft Office/365 and comfortable adopting new tools and platforms as Players Health builds out its claims technology stack.