This position is based at Fortegra, reporting directly to the Senior Claims Director. The purpose of the role is to protect the integrity and reputation of Fortegra by ensuring Pet Insurance claims are managed efficiently, fairly, and in full compliance with policy terms and regulatory requirements. The successful candidate will ensure the delivery of exceptional customer outcomes while supporting the profitable growth of Fortegra's Pet Insurance portfolio across the UK, Europe, Australia, and New Zealand.
Qualifications
- Minimum 10 years' veterinary industry experience, including direct clinical or veterinary practice experience.
- Significant Pet Insurance claims handling and operational experience.
- Extensive experience reviewing and assessing veterinary claims, treatment plans, and associated costs.
- Experience conducting claims audits, file reviews, and quality assurance activities.
- Strong understanding of Pet Insurance policy coverage, exclusions, claims processes, and regulatory requirements.
- Experience working with MGA and/or TPA delegated authority arrangements.
- Strong operational and process improvement capabilities.
- Excellent communication skills with the ability to influence stakeholders at all levels.
- Strong financial awareness with the ability to analyse claims performance, trends, and loss ratios.
- Previous experience working within an insurance company claims function, insurer, or reinsurer environment preferred.
- Experience managing delegated authority claims frameworks preferred.
- Experience supporting underwriting, product development, and pricing functions through claims insights preffered.
- Experience working across multiple markets preferred.
Primary Responsibilities
- Ensuring exceptional customer satisfaction is consistently delivered by Fortegra's MGA and TPA partners managing Pet Insurance claims.
- Providing specialist technical expertise relating to veterinary treatments, pet healthcare costs, policy coverage, and claims adjudication.
- Reviewing and enhancing Pet Insurance claims processes to ensure operational efficiency, regulatory compliance, cost control, and positive customer outcomes.
- Conducting detailed individual claim reviews with MGA and TPA partners to assess technical accuracy, consistency, claims leakage, customer outcomes, and adherence to delegated authority agreements.
- Collaborating closely with the Senior Claims Director, Underwriting, Compliance, Finance, and Product teams to effectively manage claims performance and loss ratios across the Pet Insurance portfolio.
- Supporting underwriting and product development through technical claims insights, veterinary expertise, and emerging claims trends.
- Overseeing Delegated Authority Pet Insurance claims and identifying opportunities to improve claims handling processes and controls.
- Supporting partner due diligence activities and ensuring robust claims governance during onboarding and ongoing oversight.
- Maintaining strong relationships with veterinary practices, veterinary networks, MGA partners, TPAs, and other key stakeholders.
Primary Job Functions
- Acting as Fortegra’s primary claims contact for MGA and TPA partners regarding Pet Insurance claims, complaints, referrals, and technical guidance.
- Supporting the Senior Claims Director in conducting regular partner claims audits, including detailed file reviews, and reporting against agreed standards.
- Reviewing individual claims files to assess technical quality, accuracy of decision-making, policy application, veterinary rationale, customer communication, and regulatory compliance.
- Producing detailed audit reports and SMART action plans to address identified issues and improve claims outcomes.
- Reviewing and enhancing claims handling processes, workflows, controls, and operational procedures across partner networks.
- Acting as the lead technical expert on veterinary claims matters, treatment protocols, and emerging industry trends.
- Supporting fraud prevention initiatives and acting as the key contact for suspected fraudulent claims activity.
- Providing technical advice to Underwriting teams regarding policy coverage, exclusions, benefit structures, treatment trends, and emerging risks.
- Ensuring claims management practices remain aligned with underwriting assumptions and pricing models.
- Contributing to policy wordings, Insurance Product Information Documents (IPIDs), product governance reviews, marketing materials, and client presentations.
- Conducting due diligence reviews on prospective MGA and TPA partners, assessing operational capability, claims expertise, governance, and controls.
- Organising and leading regular claims review meetings with partners, ensuring actions are documented and followed through.
- Supporting Product Oversight and Governance (POG) activities as required.
- Developing claims insights, management information, and performance reporting.
- Supporting the implementation of innovative claims technologies, digital claims solutions, and data analytics capabilities.
- Maintaining compliance with all regulatory requirements and Continuing Professional Development (CPD) obligations.
- Managing delegated authority arrangements,
- Reviewing and approving individual claims referred outside delegated authority limits.
- Setting appropriate delegated authority levels based on claims performance, complexity, and partner capability.
- Developing and maintaining robust governance frameworks for high-value or potentially reputationally sensitive claims.
- Ensuring all delegated authority arrangements remain effective and appropriately controlled.
The above cited duties and responsibilities describe the general nature and level of work performed by people assigned to the job. They are not intended to be an exhaustive list of all the duties and responsibilities that an incumbent may be expected or asked to perform.
Skills & Competencies Required
- Excellent communication and stakeholder management skills across all organisational levels.
- Strong technical understanding of veterinary treatments, diagnoses, and pet healthcare pathways.
- High levels of integrity, professionalism, and sound judgement.
- Strong analytical and investigative capabilities.
- Ability to influence and challenge partners constructively.
- Results-focused with a strong sense of accountability.
- Customer-centric approach to claims management.
- Adaptable and comfortable operating in a changing environment.
- Exceptional attention to detail.
- Strong organisational and time management skills.
- Willingness and ability to travel regularly throughout the UK and Europe
