You utilize experience within commercial property and casualty claims to monitor and assess claims activity of Third-Party Administrators (TPAs). Utilize direct systems access to monitor files, denials, reservation of rights, and settlements produced by TPAs. Verify that the TPAs are performing within their authority, utilizing agreed upon processes and practices, within the agreed upon territories and market segments. Consult with the Chief Risk Officer, Compliance, Finance, Underwriting, and IT departments to identify specific trends or problems within a program. Keep records of all monitoring activity and report to the management team, this report will include both quantitative and qualitative measures and assessments. The Claims Analyst will also develop a long-term relationship with the TPA staff and the third-party reinsurance panel participating in the risk of the program; and will communicate observations, any problems, trends, strengths, and opportunities discovered. The ultimate goal being to grow the business and maintain or improve the program results for the benefit of Client Company and the other stakeholders, including the agencies and participating reinsurance companies.
MAIN DUTIES AND RESPONSIBILITIES
- Providing management oversight to Third Party Administrators personnel by monitoring claims online using the Third-Party Administrators’ claim systems.
- Reviewing monthly loss run trends, reportable claims and/ or problematic claims.
- Provide excellent claim service to external clients and internal partners.
- Participate in claim file reviews with agents, brokers and Third-Party Administrators’ claim personnel.
- Interface with underwriting on claim status, exposures and other factors impacting their risks.
- Review and approve Third Party Administrator’s monthly claim handling fees.
- Prepare internal management reports for large losses and large loss potential; usually over $250,000.
- Conduct remote and onsite claim file audits of Third-Party Administrators.
- Perform other duties as required by management including reinsurance and subrogation.
EDUCATION AND QUALIFICATIONS
- Bachelor’s degree in Insurance or finance; or equivalent related experience
- 3+ years relevant experience in insurance.
- AIC certification preferred or other relevant course work.
- Three years of experience in claim handling, relevant litigation, or TPA management.
- Demonstrate success evaluating claims, making coverage determinations based on policy provisions, and managing litigation.
- Strong communication (verbal and written) and interpersonal skills.
- Travel is required and will vary depending on business needs and caseload.
- Working knowledge of Microsoft Word and Excel.
- Ability to manage time effectively, set priorities and meet deadlines.
The responsibilities of this position require continuous interaction:
1. Executive Team
4. Internal Associates
Ability to work and interact with departments throughout the organization.
Time management skills.
Excellent attention to detail.
Work well in a team environment
Able to maintain confidential information.