Senior Manager, TPA Claims Strategy – Governance

This is a fully remote position, open to applicants in United States.

📋 Description

• Develop the strategy, operational model, and governance framework for TPA claim programs spanning products, programs, jurisdictions, and business segments.

• Create and enhance service-level agreements, performance scorecards, claim-handling protocols, authority levels, escalation procedures, and reporting standards.

• Oversee TPA selection, onboarding, implementation, renewal, transition, and termination processes.

• Act as the senior relationship manager with TPA leadership, conducting business reviews, performance discussions, escalations, and negotiations.

• Hold TPA partners accountable for claim inventories, cycle times, customer experiences, claim quality, reserve adequacy, settlement accuracy, leakage, litigation activities, regulatory compliance, and contractual obligations.

• Evaluate TPA capacity, staffing, training, licensing, business continuity, data security, and catastrophe preparedness, and implement action plans when risks arise.

• Provide strategic guidance on complex, high-exposure, litigated, escalated, or disputed claims.

• Lead the audit, calibration, and quality assurance framework for TPA claim management.

• Identify performance trends and root causes, ensuring that corrective actions lead to sustainable improvements.

• Mentor, coach, and develop managers, claim consultants, relationship managers, and vendor oversight professionals.

• Enhance leadership capabilities and foster a culture of accountability, sound judgment, collaboration, and continuous improvement.

• Collaborate with Legal, Compliance, Finance, Actuarial, Underwriting, Procurement, Operations, Technology, and business leaders on contracts, controls, data, reporting, systems, and service delivery.

• Create and present performance dashboards, trend analyses, risk assessments, and strategic recommendations to senior and executive leadership.

• Drive continuous improvement initiatives across TPA processes, controls, technology, training, and operating models.

• Manage department expenses, TPA fees, loss adjustment expenses, claim payments, reserves, vendor charges, and audit-related costs within authorized limits.

• Identify leakage and adverse financial trends, validate contractual billing and service outcomes, and initiate corrective measures.

• Set financial performance targets and communicate results, trends, and risks to senior leadership.

• Travel for TPA site visits, business reviews, audits, implementation meetings, and leadership sessions as necessary.

⛳️ Requirements

• High school diploma or equivalent.

• Over 10 years of experience in claims or related P&C insurance, including oversight of TPA, vendor, program, or outsourced claims.

• At least 5 years of progressive leadership experience, including managing teams or multiple managers.

• Adjuster licenses for applicable states, with the capability to obtain and maintain additional licenses as necessary.

• Extensive knowledge of claim investigation, policy interpretation, coverage analysis, reserving, litigation management, settlement practices, fraud indicators, regulatory requirements, and claims financial controls.

• Proven experience in establishing governance models, service levels, vendor performance standards, claims audit programs, and corrective action strategies.

• Proficiency in interpreting and negotiating contracts, statements of work, authority levels, fee structures, reporting obligations, and governance requirements.

• Demonstrated ability to influence senior internal stakeholders and external business partners, driving accountability without direct authority.

• Experience in budget management and utilizing operational and financial data to identify trends, determine root causes, and implement measurable action plans.

• Strong skills in executive communication, presentation, negotiation, relationship management, and change leadership.

• Bachelor's degree in business, insurance, risk management, finance, or a related field is highly desirable.

• Experience managing multiple TPAs, outsourced claim programs, complex vendor relationships, or multi-state claims operations.

• Familiarity with procurement, contract negotiation, vendor risk management, implementations, conversions, or TPA transitions.

• Possession of a professional insurance designation such as AIC, CPCU, or SCLA.

• Background in claims analytics, dashboards, quality assurance programs, process improvement, or enterprise change initiatives.

• Experience in presenting to senior and executive leadership and contributing to a broader claims strategy.

🏝️ Benefits

• Opportunities for salary growth within the position.

• Access to U.S. benefit information.

• Occasional schedule flexibility to address urgent claims issues, catastrophe events, regulatory deadlines, or other critical operational requirements.