Global Claims US Claims TPA Lead

Title:

Global Claims US Claims TPA Lead

Company:

Everest Insurance Company

Job Category:

Claims

Job Description:

To manage the governance for the selection and management of all North American Claims A&H and P&C Third Party Administrators (TPA).  This will include their onboarding and due diligence (new and existing TPAs) and include the ownership of all commercial aspects of the TPA relationship. To maintain day to day relationships with all key stakeholders to ensure the smooth running of each TPA account, on-boarding in-scope client accounts, and to resolve issues as they arise with the relevant TPA and stakeholder group. To establish and maintain a framework to performance manage all TPAs which will provide improved transparency of their performance and that they consistently meet our minimum standards.

Scope

• All Claims Vendors that hold a delegation of authority. This includes Third-Party Administrators (TPA) and Self-Administering Policyholders.  (Lloyds and or Company driven business).

Key Accountabilities

• Responsible for the development, implementation, due diligence, risk management, and performance of all North American Claims Third-Party Administrators, ensuring business goals and objectives are met.
• Establish and drive the long-term strategy of Claims TPAs.
• Managing vendor relationships, performing root cause analysis and resolutions, developing, and monitoring vendor improvement plans.
• Responsibility to ensure that there is effective on-boarding of TPAs for clients not currently serviced by Client Services.
• Establishes a strong network and foster collaboration with customers, vendors, key stakeholders, and team members. (See key stakeholder section below).
• Risk Management of all Claims TPAs and other Vendors within scope of this role.
• Focus on owning, facilitating, and resolving any issue linked with a Claims TPA.
• To continuously seek process improvement / efficiencies in the utilization of Claims TPAs.
• Responsible for the management of contracts including the management of cost, service schedules, and performance parameters. Developing contract service specifications, work statements, and terms & conditions, working closely with Everest Legal.
• Monitor and oversee the payment process for TPA claims services, both ensuring prompt invoicing by the Vendor, and ensuring aged debt does not accumulate through prompt payment within agreed contact terms.
• Present reports to the Claims LOB and Underwriting management team highlighting any trends or issues.
• Align with the Claims TPA oversight team.
• Liaise with Claims QA to agree a risk/ materiality-based approach to TPA annual audits.
• Develop and own the profile of all Claims TPAs and maintain a central overview of their services, pricing and strengths and weaknesses accessible for all internal stakeholders.
• Maintain an accurate record of all TPA arrangements, documents, and contracts in the Global Claims Vendor Management SharePoint site.
• Ensure the Global Claims Database is up to date and accurate at all times.

Key Stakeholder Relationships

• Underwriters & Client Services - Regular meetings with the various underwriting divisions to support all TPA initiatives and provide expert insights to achieve practical decisions on choosing the right TPA and managing all TPA issues.
• Claims TPA Oversight Team – liaise with the oversight team to understand better the performance of each TPA from a technical perspective.
• Claims - Regular meetings with claims leaders for liaison over service, customer satisfaction and the auditing of TPAs (QA Team).
• Legal - Work with Associate General Counsel on contracts on legal issues.
• Data interface team - Work with the Data interface team on BDX, takeover claims, consolidating TPA data, etc.
• Brokers – Liaise with Brokers to manage concerns over TPA performance, but also to promote our TPA Service proposition in securing new business.
• Third Party Administrators – Regular meetings with all TPA account managers (see below), to ensure accounts are running as expected.  Quarterly Relationship with our ‘strategic’ TPAs along with the Global Claims Vendor Lead.
• Claims QA - Liaise with Global Claims QA Lead to agree annual audit regime for TPAs.
• Risk/ Compliance – As it relates to Sanctions, Financial crime and Conduct risk.
• Finance – As it relates to evaluating the financial stability of all new and existing TPAs.
• Policyholders – manage request for policyholders to self-administer claims.
• TPA Compliance Team - Work closely with the team and support the resolution of issues.