Senior Manager, TPA Claims Strategy & Governance

Assurant

1d•$103,800 - $173,300

About The Position

The Senior Manager, TPA Claims Strategy & Governance leads the strategy, governance, and performance of third-party administrator (TPA) claim programs across multiple products, business segments, and jurisdictions. This highly visible leadership role ensures TPA partners deliver fair, timely, accurate, and compliant claim outcomes while meeting customer experience, financial performance, and operational quality expectations. The role serves as senior business owner for key TPA relationships, leads claims and vendor oversight professionals, partners with senior leaders across the organization, and shapes enterprise-level management of outsourced claims operations. The position sets TPA operating models and governance frameworks; establishes and improves service-level agreements, performance scorecards, claim-handling guidelines, authority levels, escalation protocols, and reporting standards; and leads TPA selection, onboarding, implementation, renewal, transition, and termination. It directs partner performance and relationships, provides strategic guidance on complex claims, and leads audits, calibration, and quality assurance. It also develops the team, partners across functions on contracts, controls, data, reporting, systems, and service delivery, and presents performance dashboards, risk assessments, and strategic recommendations to senior and executive leadership. The role oversees department expenses and TPA-related fees, loss adjustment expenses, claim payments, reserves, vendor charges, and audit costs within delegated authority. It identifies financial trends and leakage, validates billing and service outcomes, establishes financial targets, and communicates results and risks. The work takes place in a fast-paced, highly regulated environment involving external partners, confidential claim information, and significant financial and operational accountability. Travel may be required for TPA site visits, business reviews, audits, implementation meetings, and leadership sessions. Occasional schedule flexibility may be needed for urgent claims issues, catastrophe events, regulatory deadlines, or other critical operational needs.

Requirements

High school diploma or equivalent.
10+ years of claims or related P&C insurance experience, including experience with TPA, vendor, program, or outsourced claims oversight.
5+ years of progressive leadership experience, including leading managers or multiple teams.
Adjuster licenses for applicable states, with the ability to obtain and maintain additional licenses as needed.
Deep knowledge of claim investigation, policy interpretation, coverage analysis, reserving, litigation management, settlement practices, fraud indicators, regulatory requirements, and claims financial controls.
Demonstrated experience establishing governance models, service levels, vendor performance standards, claims audit programs, and corrective action plans.
Experience 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 and drive accountability without direct authority.
Experience managing budgets and using operational and financial data to identify trends, determine root causes, and drive measurable action plans.
Strong executive communication, presentation, negotiation, relationship management, and change leadership skills.

Nice To Haves

Bachelor's degree in business, insurance, risk management, finance, or a related field.
Experience leading multiple TPAs, outsourced claim programs, complex vendor relationships, or multi-state claims operations.
Experience with procurement, contract negotiation, vendor risk management, implementations, conversions, or TPA transitions.
Professional insurance designation such as AIC, CPCU, or SCLA.
Experience with claims analytics, dashboards, quality assurance programs, process improvement, or enterprise change initiatives.
Experience presenting to senior and executive leadership and contributing to broader claims strategy.

Responsibilities

Set strategy, operating models, and governance frameworks for TPA claim programs across products, programs, jurisdictions, and business segments.
Establish and continuously improve service-level agreements, performance scorecards, claim-handling guidelines, authority levels, escalation protocols, and reporting standards.
Lead TPA selection, onboarding, implementation, renewal, transition, and termination while protecting claim continuity and customer service.
Serve as the senior relationship owner with TPA leadership and lead business reviews, performance discussions, escalations, and negotiations.
Hold TPA partners accountable for claim inventories, cycle time, customer experience, claim quality, reserve adequacy, settlement accuracy, leakage, litigation activity, regulatory compliance, and contractual commitments.
Assess TPA capacity, staffing, training, licensing, business continuity, data security, and catastrophe readiness, and drive action plans when risks emerge.
Provide strategic direction on complex, high-exposure, litigated, escalated, or disputed claims, including coverage, reserves, litigation strategy, and settlement approach within delegated authority.
Lead the audit, calibration, and quality assurance framework for TPA claim handling.
Identify performance trends and root causes and ensure corrective actions deliver sustainable improvement.
Lead, coach, and develop managers, claim consultants, relationship managers, and vendor oversight professionals.
Build leadership capability and bench strength and foster accountability, sound judgment, collaboration, and continuous improvement.
Set clear goals and expectations and ensure the team has the tools, resources, and direction needed to deliver results.
Partner with Legal, Compliance, Finance, Actuarial, Underwriting, Procurement, Operations, Technology, and business leaders on contracts, controls, data, reporting, systems, and service delivery.
Develop and present performance dashboards, trend analysis, risk assessments, and strategic recommendations to senior and executive leadership.
Lead continuous improvement initiatives across TPA processes, controls, technology, training, and operating models.
Oversee department expenses, TPA fees, loss adjustment expenses, claim payments, reserves, vendor charges, and audit-related costs within delegated authority.
Identify leakage and adverse financial trends, validate contractual billing and service outcomes, and drive corrective action.
Establish financial performance targets and communicate results, trends, and risks to senior leadership.