Global Claims US Claims TPA Lead

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.

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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.
• Claims QA Liaise with the Global Claims QA Lead to ensure alignment of TPA audit plans on an annual basis and support the facilitation of each audit.

Skills and competences

• Customer Focus : Ensuring that the internal or external customer’s perspective is a driving force behind strategic priorities, business decisions, organizational processes, and individual activities, crafting and implementing service practices that meet customers’ and own organization’s needs promoting and operationalizing customer service as a value.
• Decision Making : Identifying and understanding problems and opportunities by gathering, analysing, and interpreting quantitative and qualitative information choosing the best course of action by establishing clear decision criteria, generating, and evaluating alternatives, and making timely decisions taking action that is consistent with available facts and constraints and optimizes probable consequences.
• Driving for Results : Setting high goals for personal and group accomplishment using measurement methods to monitor progress toward goals tenaciously working to meet or exceed goals while deriving satisfaction from that achievement and continuous improvement.
• Driving Innovation : Creating an environment (culture) that inspires people to generate novel solutions with measurable value for existing and potential customers (internal or external) encouraging experimentation with new ways to solve work problems and seize opportunities that result in unique and differentiated solutions.
• Emotional Intelligence Essentials : Establishing and sustaining trusting relationships by accurately perceiving and interpreting own and others’ emotions and behaviour leveraging insights to effectively manage own responses so that one’s behaviour matches one’s values and delivers intended results.
• Problem Solving : The ability to work with other key stakeholders to identify a problem, take ownership of that problem and provide a recommended solution to the business.
• Supply Chain Management : Ability to think strategically, to initiate and embrace change based on supply chain management first principles.

Ability to negotiate professionally and effectively. An understanding of claims supply chain management and claims operations.

Knowledge

• Expert knowledge of the North American TPA market.
• Awareness of Contract and commercial law.
• Knowledge of supply chain / vendor management.
• A good knowledge of claims processes.
• Market, risk, and business awareness.
• Strong problem-solving skills and ability to prioritize multiple projects.
• Requires advanced customer service skills.
• Knowledge and computer literacy of Business software is essential. (Power BI, Qlik Sense)
• Requires expertise in operating Microsoft Office programs.

Qualifications

• Degree & Institute of Supply Management (ISM) qualified or other equivalent.
• At of least 10 years at managing Claims TPAs.
• Claims qualification preferred.

Languages

English

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.

Clickto learn more about our culture.

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. Diversity, Equity and Inclusion.

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

Regular

Time Type : Full time

Full time

Primary Location : Warren, NJ

Warren, NJ

Additional Locations :