Claims tpa oversight lead

Company:Everest Advisors (Uk), Ltd.Job Category:ClaimsJob Description:About Everest:Everest is a global leader in risk management, rooted in a rich, 50+ year heritage of enabling businesses to survive and thrive, and economies to function and flourish. We are underwriters of risk, growth, progress and opportunity. We are a global team focused on disciplined capital allocation and long-term value creation for all stakeholders, who care deeply about our impact on communities and the wider world.This is a great opportunity for someone currently in a Claims TPA oversight role, a Delegated Claims Analyst role or even a Claims Adjuster who wants to broaden their remit and move toward a more strategic, governance‑focused career path.Role PurposeAs the Claims TPA Oversight Lead, you will act as a key conduit between the Everest Claims team and the Claims Vendor Management function. You will oversee the performance and technical quality of TPAs managing claims across multiple classes of business, with a particular focus on A&H, Property & Casualty claims.You’ll help ensure TPAs and Coverholders meet regulatory expectations, follow Delegated Authority (DA) guidelines, and submit accurate bordereaux and above DA referrals on time. This includes working closely with internal stakeholders to ensure operational alignment and compliance.In this role, you will support high technical standards, operational consistency, and continuous improvement across our International TPA and Coverholder panel.Key ResponsibilitiesTechnical Oversight & Quality AssuranceDevelop and maintain technical oversight frameworks across all referenced lines of businessConduct comprehensive file reviews, QA assessments, and root‑cause analysisProvide technical guidance on complex claims, coverage interpretation, liability, and indemnity mattersMonitor reserving accuracy and indemnity spend, flagging trends and anomaliesEnsure TPAs remain within Delegated Authority levels and escalate issues where neededTPA & Coverholder Performance ManagementAct as the link between the Claims team and Claims Vendor Management, ensuring a cohesive approach to TPA and Coverholder oversightSupport TPA performance reviews, scorecards, governance meetings, and service delivery assessmentsWork closely with the Claims Performance Manager (UK & Ireland) and the Vendor Management team to ensure timely bordereaux submissions and accurate referral handlingIdentify performance gaps and assist with action plans and ongoing trackingSupport onboarding, transition, and exit processes for TPAs and CoverholdersData, MI & ReportingAnalyse claims MI to identify trends, risks, performance issues, and leakagePrepare clear, effective reporting on oversight activities for senior stakeholdersLiaise with the Global Claims QA team where appropriateStakeholder & Cross‑Functional CollaborationWork closely with Underwriting, Claims Quality Assurance, Legal, Actuarial, Finance, and Claims OperationsAct as an escalation point for complaints, and technical challenges involving TPAsSupport internal and external audit requests relating to TPA oversight and quality assuranceSkills, Experience & CompetenciesEssentialStrong claims experience across relevant classes, ideally across both insurer and TPA environmentsExperience in technical oversight, performance monitoring, or auditStrong stakeholder engagement and influencing capabilityAbility to interpret data and translate insights into meaningful actionDesirableExperience with international TPA networks or cross‑border claimsUnderstanding of Lloyd’s, Wholesale, or London Market operating modelsExperience in process improvement or project deliveryFamiliarity with claims platforms (Guidewire, ECF, IMR)QualificationsDip CII / ACII preferredDegree or equivalent experience in insurance, legal, or risk disciplinesCore CompetenciesTechnical claims expertise across A&H and P&CStrong oversight and governance mindsetAnalytical and detail‑focusedCollaborative and able to work cross‑functionallySound decision‑making skillsCustomer‑focused with a commitment to fair outcomesStrategic, solutions‑oriented thinkingCommercial awarenessAbility to work effectively in a matrixed environmentStrong communication skills, both written and verbalIf you’re passionate about improving claims performance, strengthening vendor relationships, and ensuring exceptional customer outcomes, we’d love to hear from you.What if I don’t meet every requirement? At Everest we are dedicated to building an inclusive and authentic workplace. So, if you are excited about this role but your past experience doesn’t align perfectly with every element in the job description, we still encourage you to apply. You may be just the right candidate for this or other roles. Please let us know if you need any accommodations throughout the application or interview process.Our CultureAt Everest, our purpose is to provide the world with protection. We help clients and businesses thrive, fuel global economies, and create sustainable value for our colleagues, shareholders and the communities that we serve. We also pride ourselves on having a unique and inclusive culture which is driven by a unified set of values and behaviors.Our Values are the guiding principles that inform our decisions, actions and behaviors. They are an expression of our culture and an integral part of how we work: Talent. Thoughtful assumption of risk. Execution. Efficiency. Humility. Leadership. Collaboration. Inclusion and Belonging.Our Colleague Behaviors define how we operate and interact with each other no matter our location, level or function: Respect everyone. Pursue better. Lead by example. Own our outcomes. Win together.All colleagues are held accountable to upholding and supporting our values and behaviors across the company. This includes day to day interactions with fellow colleagues, and the global communities we serve.Type:RegularTime Type:Full timePrimary Location:LondonAdditional Locations:Privacy Notice | Everest (everestglobal.com)
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