Claims Manager, TPA Oversight

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

Minimum Qualifications:

• A Bachelor’s degree or the equivalent education and/or experience.
• Candidate should have 8 years of progressive claims management and TPA oversight experience.
• Adjuster licenses, as mandated by specific states, are required.
• Experience managing a team.

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 technical 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:

• Proven track record of effectively managing TPAs and improving claims handling processes.
• Claims operations experience with the ability to drive process and best practices.
• Comprehensive understanding of claims, litigation, and trial process.
• Strong business and financial acumen, including negotiation skills, data analysis, critical thinking, business analysis and organizational skills.
• Deep knowledge of coverage analysis, multi-jurisdictional compliance, and claims management platforms.
• 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, ensure continuous improvement, and increase efficiency.
• Broad-based claims knowledge across multiple specialty lines.
• Experience in excess/umbrella, Property, D&O/E&O claims, and/or general liability.
• Ability to travel as needed.

Additional Information:

• Full benefit package including medical, dental, life, vision, company paid short/long term disability, 401(k), tuition assistance and more.
• Fortegra is not accepting unsolicited resumes from search firms for this position.
• Internal Notice: As part of our commitment to talent development, this position is open for internal promotion applications at the time of public posting.