Job Description

Claims Director – TPA Oversight

A leading Property & Casualty insurance carrier is seeking an experienced Claims Director to oversee Third-Party Administrator (TPA) relationships. This role is responsible for ensuring operational excellence, regulatory compliance, and strategic alignment with organizational claims objectives.

Compensation Package

• $120,000 to $150,000+/year total compensation (based on experience)
• Annual bonus potential
• Comprehensive benefits package (health, dental, vision, 401k, etc.)
• Opportunities for professional development and advancement

Job Description

• Oversee relationships with assigned TPAs, ensuring compliance with company guidelines, service level agreements, and regulatory requirements.
• Monitor and evaluate TPA performance metrics, including claims quality, timeliness, and expense management.
• Collaborate with TPAs to implement process improvements, claim strategies, and operational initiatives.
• Provide leadership, guidance, and escalation support for complex claims issues.
• Partner with internal claims leadership, underwriting, and actuarial teams to ensure alignment on business objectives and portfolio performance.
• Conduct regular audits and reviews to ensure claims practices comply with company standards and applicable regulations.
• Develop and deliver performance reports, trend analysis, and recommendations to senior leadership.
• Participate in strategic planning and assist in TPA selection, contract negotiation, and renewals.

Requirements

• Bachelor’s degree in Insurance, Risk Management, Business, or related field; advanced degree preferred.
• Minimum 10 years of claims experience within the insurance industry, including significant experience managing TPAs.
• Strong knowledge of P&C insurance claims operations, including liability, property, workers’ compensation, and commercial lines.
• Proven leadership and team management experience.
• Excellent analytical, negotiation, and communication skills.
• Experience with claims technology systems and reporting tools.
• Ability to influence and collaborate with internal and external stakeholders.

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.

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