Description
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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 Purpose
As 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 Responsibilities
Technical Oversight & Quality Assurance
1. Develop and maintain technical oversight frameworks across all referenced lines of business
2. Conduct comprehensive file reviews, QA assessments, and root‑cause analysis
3. Provide technical guidance on complex claims, coverage interpretation, liability, and indemnity matters
4. Monitor reserving accuracy and indemnity spend, flagging trends and anomalies
5. Ensure TPAs remain within Delegated Authority levels and escalate issues where needed
TPA & Coverholder Performance Management
6. Act as the link between the Claims team and Claims Vendor Management, ensuring a cohesive approach to TPA and Coverholder oversight
7. Support TPA performance reviews, scorecards, governance meetings, and service delivery assessments
8. Work closely with the Claims Performance Manager (UK & Ireland) and the Vendor Management team to ensure timely bordereaux submissions and accurate referral handling
9. Identify performance gaps and assist with action plans and ongoing tracking
10. Support onboarding, transition, and exit processes for TPAs and Coverholders
Data, MI & Reporting
11. Analyse claims MI to identify trends, risks, performance issues, and leakage
12. Prepare clear, effective reporting on oversight activities for senior stakeholders
13. Liaise with the Global Claims QA team where appropriate
Stakeholder & Cross‑Functional Collaboration
14. Work closely with Underwriting, Claims Quality Assurance, Legal, Actuarial, Finance, and Claims Operations
15. Act as an escalation point for complaints, and technical challenges involving TPAs
16. Support internal and external audit requests relating to TPA oversight and quality assurance
Skills, Experience & Competencies
Essential
17. Strong claims experience across relevant classes, ideally across both insurer and TPA environments
18. Experience in technical oversight, performance monitoring, or audit
19. Strong stakeholder engagement and influencing capability
20. Ability to interpret data and translate insights into meaningful action
Desirable
21. Experience with international TPA networks or cross‑border claims
22. Understanding of Lloyd’s, Wholesale, or London Market operating models
23. Experience in process improvement or project delivery
24. Familiarity with claims platforms (Guidewire, ECF, IMR)
Qualifications
25. Dip CII / ACII preferred
26. Degree or equivalent experience in insurance, legal, or risk disciplines
Core Competencies
27. Technical claims expertise across A&H and P&C
28. Strong oversight and governance mindset
29. Analytical and detail‑focused
30. Collaborative and able to work cross‑functionally
31. Sound decision‑making skills
32. Customer‑focused with a commitment to fair outcomes
33. Strategic, solutions‑oriented thinking
34. Commercial awareness
35. Ability to work effectively in a matrixed environment
36. Strong communication skills, both written and verbal
If you’re passionate about improving claims performance, strengthening vendor relationships, and ensuring exceptional customer outcomes, we’d love to hear from you.
Our Culture
At 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. Click to learn more about our culture.
37. 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.
38. 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:
Regular
Time Type:
Full time
Primary Location:
London
Additional Locations: