Overview
Everest is a global leader in risk management with a 50+ year heritage. We are underwriters of risk, growth, progress and opportunity, with a global team focused on disciplined capital allocation and long-term value creation for all stakeholders.
Role Purpose
As the Claims TPA Technical Oversight Lead, you will oversee the performance and provide technical assurance of Third-Party Administrators (TPAs) handling Accident & Health (A&H) and Property & Casualty (P&C) claims. You will ensure outsourced claims operations deliver accurate, timely, and fair outcomes in line with regulatory expectations, internal policies, and customer commitments. You will drive technical excellence, operational efficiency, and continuous improvement across a diverse TPA panel, and maintain robust oversight frameworks to manage risk.
Responsibilities
* Technical Oversight & Quality Assurance: establish and maintain technical claims handling oversight frameworks for A&H and P&C, ensuring compliance with internal standards; conduct deep-dive file reviews, quality assurance assessments, and root-cause analyses; provide technical guidance to TPAs on complex claims including policy interpretation, liability, and indemnity decisions; monitor reserving accuracy and indemnity spend, escalating material trends as needed; ensure TPAs operate within delegated authorities and escalate breaches promptly.
* TPA Performance & Relationship Management: support Global Claims Vendor Management in performance reviews, scorecards, and governance meetings for A&H and P&C TPAs; ensure claims are handled efficiently and in line with customer service standards; identify performance gaps, define corrective actions, and track improvements; support onboarding, transitioning, and offboarding of TPAs as required.
* Data, MI & Reporting: analyze claims MI across A&H and P&C to identify risks, performance trends, and leakage; report oversight activities, technical reviews, and audit outcomes to senior stakeholders, coordinating with Global Claims QA where appropriate.
* Stakeholder & Cross-Functional Collaboration: work with underwriting, claims vendor management, legal, actuarial, and finance to align claims strategies and inform business decisions; act as escalation point for disputes or technical challenges related to TPA-managed claims; participate in QA audit reviews and respond to audit requests related to TPA oversight.
Skills, Experience & Competencies
Essential:
* Solid claims experience across A&H and P&C (minimum 7 years PQE), ideally in both insurer and TPA environments.
* Strong track record in technical claims oversight, performance management, and audits.
* Adept at managing stakeholders and influencing outcomes.
* Comfortable interpreting data and producing insightful performance reports.
Desirable:
* Experience with international TPA networks or cross-border claims oversight.
* Familiarity with Lloyd’s or London Market operating models.
* Led or contributed to process improvement or project delivery initiatives.
* Experience with claims platforms like Guidewire, ECF, IMR, Trax, etc.
Qualifications
* Professional insurance qualification (e.g., Dip CII or ACII) preferred.
* Degree or equivalent experience in insurance, legal, or risk-related disciplines.
Core Competencies
* Technical Mastery: deep claims expertise across A&H and P&C.
* Governance-Oriented: strong understanding of risk controls and operational assurance.
* Analytical Thinking: ability to translate data into meaningful action.
* Collaborative: works well with internal and external stakeholders.
* Decisive: confident making sound, defensible technical decisions.
* Customer-Centric: advocates for fair and positive customer outcomes.
Culture
Our purpose is to provide protection and help clients and businesses thrive, with an inclusive culture driven by values and behaviors. Values: Talent, Thoughtful assumption of risk, Execution, Efficiency, Humility, Leadership, Collaboration, Inclusion and Belonging. Behaviors: Respect everyone, Pursue better, Lead by example, Own our outcomes, Win together. All colleagues are held accountable to upholding these values and behaviors.
Type: Regular
Time Type: Full time
Primary Location: London
Privacy Notice | Everest
#J-18808-Ljbffr