Third-Party Administrator TPA - Data Manager -- CHODC6118719

TPA Data Manager, Subject Matter Expert (SME), and Business Data Analyst to support its existing TPA data landscape and the modernization of its Third-Party Administrator (TPA) Data Services platform. This role will lead the TPA Data Services workstream and support enterprise transformation initiatives, including Project NOVA and Guidewire modernization. The position is responsible for translating business requirements into scalable data solutions, improving TPA data quality and operational processes, and supporting the migration from legacy data ingestion and reporting methods to modern cloud-based data platforms leveraging Microsoft Fabric, Azure, and advanced analytics capabilities. The ideal candidate will have deep TPA operations knowledge, strong business analysis skills, and the ability to collaborate with stakeholders and technology teams to drive modernization efforts and business outcomes.

Key Responsibilities:

• Lead and mentor a team of Business Data Analysts, Data Engineers, and TPA Data Analysts.

• Establish team goals, priorities, performance expectations, and professional development plans.

• Manage hiring, onboarding, coaching, performance reviews, and career progression discussions.

• Foster a culture of accountability, collaboration, continuous improvement, and customer service.

• Develop TPA domain expertise across the team through training and knowledge-sharing initiatives.

• Build succession plans and cross-functional skill development programs.

• Serve as the primary SME for TPA data, claims, policy, and financial reporting processes.

• Understand end-to-end claim lifecycles and TPA operational workflows.

• Provide guidance on industry standards, regulatory reporting, bordereaux processing, and carrier reporting requirements.

• Partner with Claims, Underwriting, Finance, Actuarial, and Risk Management teams to identify improvement opportunities.

• Define and document business rules, data definitions, and operational metrics.

• Elicit, document, and manage business requirements and user stories.

• Facilitate workshops and working sessions with business stakeholders and TPAs.

• Translate business requirements into functional and technical specifications.

• Create process maps, workflows, future-state operating models, and requirements documentation.

• Support Agile delivery teams through backlog refinement, sprint planning, and user acceptance testing.

• Analyze TPA claims, financial, and operational data from multiple sources.

• Perform data mapping and transformation analysis across legacy and target platforms.

• Define source-to-target mappings and business transformation rules.

• Support data conversion, reconciliation, and validation activities.

• Collaborate with Data Engineering teams on ingestion frameworks, data quality controls, and modernization initiatives.

• Assist in developing enterprise KPIs, dashboards, and operational reporting.

• Define and monitor data quality rules and controls.

• Identify data anomalies and root causes.

• Establish data stewardship practices across TPA programs.

• Support data cataloging, metadata management, and business glossary initiatives.

• Partner with governance teams to ensure compliance with regulatory and audit requirements.

• Serve as a liaison between business stakeholders, TPAs, vendors, and technology teams.

• Provide executive-ready summaries and status updates.

• Facilitate issue resolution and drive decisions across multiple teams.

• Coordinate with external TPAs, software vendors, and implementation partners.

Required Qualifications:

• 10 years of experience in Property & Casualty insurance.

• 5 years of experience working with TPA operations, claims administration, or managed claims programs.

• 5 years of Business Analyst or Data Analyst experience.

• Experience supporting enterprise data modernization or transformation initiatives.

• Experience working with Agile delivery methodologies.

• Strong understanding of TPA claim administration, Workers’ Compensation, General Liability, Auto Liability, and Property Claims.

• Strong understanding of claim financial transactions, loss runs, bordereaux, reserve and payment reporting, insurance operational reporting, and carrier-TPA data exchange processes.

• Proficiency in SQL and data analysis.

• Advanced Excel skills.

• Experience with Microsoft Fabric, Azure, or cloud analytics platforms.

• Experience with Power BI reporting and dashboard development.

• Knowledge of data mapping, transformation analysis, data quality analysis, ETL concepts, and API and file-based integrations.

• Strong business analysis skills, including requirements gathering, process modeling, gap analysis, user story creation, and UAT planning and execution.

• Strong stakeholder management, documentation, and presentation skills.

• Strong analytical problem-solving and structured root-cause analysis capabilities.

• Clear written and verbal communication skills, with the ability to communicate effectively with technical and nontechnical audiences.

• Strong business acumen and the ability to connect analytics initiatives to measurable business outcomes.

• Accountability, ownership, and disciplined follow-through.

• Ability to manage priorities, communicate risks proactively, and work effectively in a changing environment.

• Collaborative, service-oriented mindset with a commitment to data quality and user experience.

• Continuous-learning mindset and interest in modern analytics, automation, and AI-enabled delivery methods.

Preferred Qualifications:

• Experience with Guidewire ClaimCenter.

• Experience working with RMIS platforms.

• Experience with bordereaux processing and claims data conversions.

• Understanding of data warehousing and dimensional modeling.

• Experience with Microsoft Fabric Lakehouse and Warehouse architectures.

• Experience working with insurance mergers, acquisitions, or system migrations.

• CBAP, PMI-PBA, or equivalent certification.

Additional Role Expectations:

• Establish documented business and data standards across all TPA programs.

• Reduce manual effort associated with TPA data analysis and reconciliation.

• Improve TPA data quality, timeliness, and completeness.

• Support the successful onboarding of new TPA data sources into the enterprise platform.

• Deliver business requirements for Project NOVA and TPA modernization initiatives.

• Become the trusted SME for TPA data across Claims, Finance, Actuarial, and Technology teams.

• Drive measurable improvements in operational reporting and decision-making.

• Work in a hybrid environment, collaborating across business, technology, and partner teams.

• Participate in planning, design, testing, deployment, production support, and continuous-improvement activities.

• Provide occasional after-hours support for planned releases or critical production issues.