TPA Manager

Discipline: Claims
Job type: Permanent
Contact email: emily@weareedenbrook.com
Job ref: J5250
Published: 4 days ago
An exciting opportunity reporting into the Head of Claims, the successful candidate will be responsible for monitoring the performance of internal and TPA claims processing activities. Responsibilities: • Monitor the performance of internal and TPA claims processing activities, addressing issues or escalating to the HOC. • Assist in defining KPIs to monitor TPA performance, supported by the business. • Conduct due diligence on TPAs during onboarding to evaluate processing capabilities. • Oversee operational onboarding and integration of TPAs into processes and systems. • Perform ongoing audits to ensure TPA compliance with internal and contractual standards. • Manage day-to-day engagement with TPAs to identify and mitigate performance issues. • Participate in claim file reviews with the business and external audit partners. • Support the Head of Claims in handling claims outside of Delegated Authority. • Coordinate with reinsurer claims teams to ensure timely and accurate reporting. • Prepare and attend quarterly TPA performance reviews, assessing KPIs, standards, audits, and client feedback. • Ensure continuous improvement of claims activities in both operational and data quality aspects. Key Duties: • Conduct due diligence on TPAs during onboarding, including service offering, staff competency, operational capabilities, systems functionality, and data quality. • Oversee the operational onboarding of TPAs, including process hand-offs, data delivery, monitoring processes, escalation procedures, reporting, and relationship management. • Manage day-to-day activities, escalating issues that impact contractual or industry SLAs, and ensuring claims are processed efficiently and transparently. • Support the Head of Claims with breach and complaint management. • Collaborate with the Head of Claims, COO, Underwriters, Actuaries, and specialists to review TPA claims files regularly. • Conduct and document TPA audits with staff and specialists. • Assist with quarterly TPA performance reviews, measuring performance against KPIs, requirements, and client feedback. • Coordinate with HOC and Compliance Officer for regular audits to ensure TPAs maintain industry standards. • Proactively follow up on audit outcomes to ensure TPAs maintain agreed service standards. • Provide claims-specific insights for MGA and reinsurer reports and meetings. The Ideal Candidate: • Practical experience managing claims, particularly with TPAs and specialist advisory companies. • Experience in managing specialty insurance claims; other classes are a plus. Required: • Proven experience managing claims TPAs. • Strong understanding of claims processes and performance indicators. • Knowledge or experience in claims handling. Desired: • Experience using data to manage performance and identify improvement opportunities. • Some experience in claims audits. • Claims handling experience is advantageous. • Exposure to underwriting management is beneficial.