Manager, TPA Oversight

Riverstone Resources

About The Position

This role will be responsible for monitoring, reviewing, and coordinating the activities of TPAs handling multi-line commercial cases with an emphasis on worker’s compensation claims including analyzing coverage issues, establishing accurate reserves, and resolution of cases on behalf of affiliate insurers. Oversight also includes TPA selection, audit and review of compliance with contractual, legal obligations and other internal controls, assistance with TPA contract drafting and placement, preparation of special handling instructions, TPA fraud reporting, training and compliance, preparation of workflows to ensure accurate information exchange with TPA partners, and preparation and analysis of reports reflective of TPAs meeting key performance indicators, benchmarks and other obligations.

Requirements

Minimum of 7 years’ experience of adjusting multi-line claims and worker’s compensation claims, including large losses, preferably in multiple jurisdictions.
Four-year college degree required or equivalent work experience.

Nice To Haves

Claims technical supervisory or management experience preferred.
Experience analyzing statistical reports of multi-line claims and a proven ability to identify trends.
JD, CPCU, SCLA, CCLA

Responsibilities

Coordinates TPA selection, review of compliance with contractual, legal obligations and other internal controls.
Assists with TPA contract drafting and placement, preparation of handling instructions, TPA fraud reporting, training and compliance, preparation of workflows to ensure accurate information exchange with TPA partners.
Responsible for all results of all assigned TPA oversight
Coordinates with TPA to develop KPI reports and other operational reports to manage the TPA towards those priorities.
Reviews loss notices; confirms and interprets policy coverage; establishes accurate reserves; investigates and handles claims involving multi-line commercial cases; reviews reimbursement requests and initiates payment as appropriate.
Consistently delivers superior customer service to both internal and external business partners.
Develops creative ideas and solutions to real time business problems and /or business opportunities; Takes reasonable, calculated risks even if failure is possible.
Ensures proper file setup, file documentation, reserving, general handling and application of company procedure and coverage interpretation.
Conducts audits of TPAs; assesses claim handling performance of the TPAs and remedies issues as they arise; directs TPA activities.
Participates in development of claim-handling techniques, including TPA oversight, defense coordination, expense control, and strategy.
Reports on the results of TPA managed business and provides other claims information to senior management for selected losses and maintains specific financial and reporting metrics for reporting to management.
Maintains diary control of reported cases to ensure maintenance of proper reserves to reflect the company's exposure and adequate notice to reinsurers, and recovery of specific amounts owed to the company, where applicable.
Seeks continuous development by identifying areas for growth and improvement. Works with the continuous improvement team to implement process and technical improvements.