TPA Manager, Specialty Claims

The TPA Manager, Specialty Claims will provide oversight of Specialty Claims Third Party Administrators (TPAs) while managing casualty, property, inland marine, excess/umbrella, and professional liability claims. Duties will include the leadership of TPA oversight adjusters, participation in TPA selection, audits and reviews, and assistance with onboarding and setup of new TPAs. Additionally, the ideal candidate will possess experience in claims management, TPA contract negotiation and compliance.

Minimum Qualifications:

• Bachelor's degree required.
• 5 + years of experience in TPA oversight of claims management.
• Adjuster's license.

Primary Job Functions:

• Oversee the performance of TPA operations to ensure adherence to service level agreements and claim handling guidelines.
• Assist with the negotiation of services, contracts and service level agreements for TPAs utilized by Fortegra.
• Conduct regular audits of TPA Operations to ensure compliance with company standards and regulatory requirements.
• Review and approve authority levels for claims settlements, ensuring they are in line with company policies.
• Serve as the primary point of contact for assigned TPAs, fostering strong relationships and effective communication.
• Analyze claims data to identify trends, areas of risk and opportunities for cost savings.
• Provide expert guidance on complex claims and support TPAs in the resolution of high-exposure cases
• Manage key relationships with leadership at TPAs to ensure claims are being handled in line with service level agreements and quality expectations.
• Lead business review meetings to discuss performance metrics, areas for improvement and strategic planning.
• Oversee claims adjusters assigned to handle TPA escalations and day to day oversight.
• Ensure compliance with all local, federal, and state regulations related to claims while minimizing risk/exposure to the organization.
• Participate in underwriting, actuarial, client or broker meetings regularly.
• Demonstrate knowledge of severity files and trends.
• Provide reserve and settlement authority to claim staff in connection with their requests and recommendations.
• Build and develop organizational talent.
• Other duties as assigned.

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:

• Provide track record of effectively managing TPAs and improving claims handling processes.
• Claims operations experience with the ability to drive process and best practices.
• Strong business and financial acumen, including negotiation skills, data analysis, critical thinking, business analysis and organizational skills.
• High level of emotional intelligence, influencing skills, and communication skills to enable collaboration with a variety of key stakeholders including senior executive stakeholders.
• Excellent verbal and written communication skills.
• Proven ability in the use of metrics and data to drive performance, assure continuous improvement, and increase efficiency.
• Broad-based knowledge of claims across multiple specialty lines.
• Experience in excess/umbrella, Property, D&O/E&O claims, and/or general liability.
• Ability to travel as needed.
• Proficient in Microsoft Excel.

Additional Information:

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