TPA Manager

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.

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.