Claims Operations Director
3 weeks ago
At Ascot Group, we're seeking a highly experienced Vice President, Claims TPA Manager to lead our Third-Party Administrator (TPA) management team. This role involves providing strategic direction for our programs and captives, collaborating with internal and external partners on TPA management and claims operations.
Key Responsibilities:
- Lead the negotiation of services, contracts, and service level agreements for all TPAs utilized by Ascot in the U.S.
- Proven track record of managing all aspects of TPA relationships and strategy.
- Oversee the performance of TPAs to ensure adherence to service level agreements and claim handling guidelines.
- Conduct regular audits of TPA operations to ensure compliance with company standards and regulatory requirements.
- Review and approve authority levels for claims settlements, ensuring they are in line with company policies.
- Lead stewardship meetings to discuss performance metrics, areas for improvement, and strategic planning.
- Collaborate with internal teams, including underwriting and actuarial, to align claims handling procedures with company objectives.
- Develop and implement best practices for claims handling and management across all TPAs.
- Serve as the primary point of contact for TPAs, fostering strong relationships and effective communication.
- Analyze claims data to identify trends, areas of risk, and opportunities for cost savings.
- Provide expert guidance on complex claims and support TPAs in the resolution of high-exposure cases.
- Manage key relationships with senior leaders at the TPAs to ensure claims are being handled in line with service level agreements, and quality expectations.
- Bachelor's degree in Business Administration, Finance, or a related field. A Juris Doctor or advanced degree in a related field is preferred.
- Minimum of 10 years of claims handling experience, TPA Management background working directly for a TPA or managing a carrier/program/TPA relationship is a plus.
- Proven track record of effectively managing TPAs and improving claims handling processes.
- Claims operations experience with the ability to drive process, best practices, and operational strategy from both an operational and technical perspective.
- Strong critical thinking skills, with the ability to influence others when needed.
- Excellent organizational, desk management, and prioritization skills with the ability to work independently and as part of a team.
- Must be positive, self-motivated, and possess strong interpersonal, communication, and presentation skills.
- Solution-oriented team player with a strong relationship management skill set working with both internal and external stakeholders and customers.
- Proficiency in claims management software and Microsoft Office Suite.
- Ability to travel as needed.
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