Claims TPA Technical Oversight Lead

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Job Description:

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.

Role Purpose

As the Claims TPA Technical Oversight Lead you will be responsible for overseeing the performance and providing technical assurance of Third-Party Administrators (TPAs) handling both Accident & Health (A&H) and Property & Casualty (P&C) claims on behalf of the company. You will ensure that outsourced claims operations consistently deliver accurate timely and fair outcomes in accordance with regulatory expectations internal policies and customer commitments.

In this role youll drive technical excellence operational efficiency and continuous improvement across a diverse TPA panel within Everests International Claims operations. Youll also be tasked with maintaining robust oversight frameworks that effectively manage risk.

Key Responsibilities:

Technical Oversight & Quality Assurance

• You will establish and maintain technical claims handling oversight frameworks for both A&H and P&C lines ensuring compliance with internal standards.

• Youll conduct deep-dive file reviews quality assurance assessments and root-cause analyses of claims handling issues.

• Youll provide technical guidance to TPAs on complex claims including policy interpretation liability and indemnity decisions.

• You will monitor reserving accuracy and indemnity spend escalating material trends and anomalies as needed.

• Youll ensure that TPAs operate within their delegated authorities escalating any breaches promptly.

TPA Performance & Relationship Management

• Youll support the Global Claims Vendor Management team in conducting performance reviews maintaining scorecards and running governance meetings for a panel of A&H and P&C TPAs.

• You will ensure claims are handled efficiently empathetically and in line with customer service standards.

• Youll identify performance gaps help define corrective actions and assist the Claims Vendor Management team in tracking improvements.

• Youll support the onboarding transitioning and offboarding of TPAs as required.

Data MI & Reporting

• You will analyze claims MI across the A&H and P&C portfolios to identify risks performance trends and leakage.

• Youll report on oversight activities technical reviews and audit outcomes to senior stakeholders coordinating with the Global Claims QA team where appropriate.

Stakeholder & Cross-Functional Collaboration

• Youll work closely with underwriting claims vendor management legal actuarial and finance teams to align claims strategies and inform business decisions.

• You will act as the escalation point for disputes complaints or technical challenges related to TPA-managed claims.

• Youll participate in QA audit reviews and respond to internal/external audit requests related to TPA oversight.

Skills Experience & Competencies

Essential:

• You bring solid claims experience across A&H and P&C lines (minimum 7 years PQE) ideally gained within both insurer and TPA environments.

• You have a strong track record in technical claims oversight performance management and audits.

• Youre adept at managing stakeholders and influencing outcomes.

• You are comfortable interpreting data and producing insightful performance reports.

Desirable:

• Youve worked with international TPA networks or managed cross-border claims oversight.

• Youre familiar with Lloyds or London Market operating models.

• Youve led or contributed to process improvement or project delivery initiatives.

• You have experience with claims platforms like Guidewire ECF IMR Trax etc.

Qualifications

• A professional insurance qualification (e.g. Dip CII or ACII) is preferred.

• You hold a degree or possess equivalent experience in insurance legal or risk-related disciplines.

Core Competencies

• Technical Mastery: You bring deep claims expertise across both A&H and P&C products.

• Governance-Oriented: You have a strong understanding of risk controls and operational assurance.

• Analytical Thinking: You can translate data into meaningful action.

• Collaborative: You work well with both internal and external stakeholders.

• Decisive: Youre confident making sound defensible technical decisions.

• Customer-Centric: You consistently advocate for fair and positive customer outcomes.

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What if I dont 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 doesnt 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 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. Clickhereto learn more about our culture.

• Our Valuesare 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 Behaviorsdefine 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.

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