TPA Claims Oversight Manager

This position is based at Fortegra, reporting directly to the Snr Claims Director.

Primary Responsibilities

• Ensuring exceptional customer satisfaction is consistently delivered by Fortegra’s TPA/MGA partners.
• Providing specialised technical claims expertise to clients and third-party administrators involved in distributing and managing general and miscellaneous non-life insurance business.
• Collaborating closely with the Snr Claims Director, as well as the Underwriting, Compliance, and Finance departments, to effectively manage and control claims costs/loss ratios within the UK and EU business units.
• Overseeing the implementation and ongoing management of claims funds with all MGA and TPA partners, maintaining clear and documented processes, ensuring timely partner payments, and conducting regular balance reviews to control funding exposure and prevent unnecessary financing.
• Overseeing Delegated Authority claims, including the identification and implementation of enhancements to the claims handling processes, aimed at improving outcomes for both customers and the business.

The scope covers opportunities in the UK and Europe for the following product categories:

• Automotive extended warranty contracts
• GAP insurance
• Cosmetic Protection Products
• Key Insurance
• Mis-fueling
• Roadside Assistance
• Motor and Car Hire Excess
• Domestic Appliance extended warranty
• Furniture Insurance – AD, structure, stains
• Mobile Phone / Gadget insurance – AD, theft, loss, screen protection
• Pet Insurance

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.

Primary Job Functions

• Serving as a primary contact for partners on claims-related inquiries, complaints, and general claims advice.
• Supporting the Claims Director in conducting regular partner claims audits, providing detailed reports with SMART action plans to mitigate claims leakage, manage claims costs, and ensure positive customer outcomes.
• Acting as the main fraud contact for partners and coordinating with Fraud Investigator Suppliers.
• Using technical expertise to advise underwriters on product coverage levels and key amendments or additions to product terms and conditions.
• Ensuring that claims management processes align with pricing assumptions and that partners administer business in accordance with policy terms.
• Contributing to policy wordings, Insurance Product Information Documents (IPIDs), marketing materials, and client presentations.
• Carrying out due diligence on prospective new partners, ensuring strong partner selection that supports scalable growth, and enables smooth onboarding.
• Organising regular client claims review meetings with partners and underwriters, ensuring that minutes are recorded, and SMART actions are communicated to relevant parties.
• Assisting in the creation of Product Oversight and Governance (POG) papers as needed.
• Supporting the Claims Director in establishing and implementing operational KPIs and generating claims insights.
• Adhering to regulatory approval processes, ensuring compliance, and completing CPD training as required.
• Management of claims funds with all MGA and TPA partners, maintaining clear and documented processes, ensuring timely partner payments, and conducting regular balance reviews to control funding exposure and prevent unnecessary financing.
• Developing and managing an effective claim Delegated Authority (DA) process for a diverse claim’s portfolio, including:

• Overseeing individual DA claims, providing final approvals and detailed decision rationales.
• Analysing claims costs and frequencies to set appropriate DA levels for each client and third-party administrator (TPA).
• Designing and ensuring the implementation of robust DA processes and guidelines for high-value claims or those with potential reputational impact.

Skills And Competencies Required

• Exhibits effective communication skills across all levels.
• Upholds exacting standards of integrity, with a proven record of trustworthiness, loyalty, and honesty.
• Collaborates effectively as a team player.
• Results-oriented, self-motivated, and accountable for actions and outcomes.
• Maintains a strong focus on client and customer satisfaction.
• Maintains a positive attitude and adapts readily to change.
• Possesses meticulous attention to detail.
• Manages time efficiently to meet critical deadlines.

Experience, Qualifications Required

• Proven experience in a Claims Operations role.
• Strong operational skills, including both business process and systems.
• Strong change management skill set including experience as a Claims SME.
• Excellent communication skills, with the ability to influence stakeholders across all levels, including senior management.
• Strong financial acumen and intuition, with the ability to handle large and complex issues/data.

Additional Information

• Full benefit package including medical, dental, life, vision, company paid short/long term disability, 401(k), tuition assistance and more.

Recruitment Updates

Fortegra has recently been made aware of unauthorized communications regarding career opportunities by individuals not associated with Fortegra or our recruitment team. Fortegra will only contact you from the Fortegra domain address ("@fortegra.com"). If you receive a message from someone posing as a Fortegra recruiter via text message, WhatsApp, Telegram or other messaging platform, please report it as phishing and block the sender. Please be aware of job fraud(s) – all correspondence emails regarding your candidacy will come from our Fortegra.com email address. Thank you. Fortegra is not accepting unsolicited resumes from search firms for this position.