Claims Manager

3 weeks ago

Tampa, United States Everspan Group Full time

Job Summary: This role functions as a liaison between the Everspan Claims Department and its business partners (underwriting, MGAs, TPAs, reinsurers, brokers, insureds and claimants) by providing necessary administrative support as well as serving as a back-up resource to the Claims Team in the First Notice of Loss, Payment Processing and other administrative functions as needed.


Primary Duties/Responsibilities:

  • Manage and maintain claims email inbox and provide telephone support for claims calls
  • Complete claim system transactions as assigned, including new claim set ups (if needed) and triaging new claims to the correct line of business
  • Provide daily work oversight in support of Head of Claims and Professional Staff
  • Serve as a technical expert for claims and acts as a problems solver for systems and procedural matters
  • Assist Management in reviewing existing and future processes to ensure best practices are implemented and followed
  • On an ad-hoc basis, support Ambac-Group claims initiatives, including but not limited to advising on claims/TPA diligence and overall claims/TPA operational matters
  • Provide training, support and clarification to others as requested
  • Work with business partners to ensure the timely processing of information related to insurance policies
  • Analyze and validate data to ensure accuracy and quality
  • Provide oversight to TPAs and any third party vendors as needed
  • Assist in problem solving all clerical processes and coding entries
  • Assist in Vendor Payment Allocation and TPA account funding
  • Responsible for operational readiness of TPAs
  • Assist with coordination of projects and special assignments such as audit preparation
  • Access information in response to inquiries from attorneys, brokers, insureds and outside business partners
  • Maintain records and complete projects specific to accounts handled by Management
  • Gather necessary information compiling ad hoc claims reports
  • Maintain panel counsel list and preferred vendor list as directed by Head of Claims
  • Monitor and respond to critical business and customer needs in a timely and professional manner
  • Ensure establishment of a working electronic data exchange initiatives, including claims bordereaux transmission process
  • Import of all TPA bordereaux for evaluation and reconciliation
  • Improve quality, simplify processes, and reduce cycle times of claims procedures


Education, Experience, and Other Qualifications:

  • Bachelor's degree or equivalent experience
  • 5+ years insurance and/or claim handling experience (commercial claims a plus)
  • Knowledge of multiple state statutes, including good faith claim handling practices, regulations, and guidelines
  • Excellent communications (telephone, e-mail and interpersonal) skills as required
  • Exceptional attention to detail and a customer-centric outlook
  • Strong analytical and organizational skills
  • Software: All Windows operating systems, Microsoft Word, Excel
  • Knowledge of various claim systems and claim processing.
  • Ability to analyze, think outside the box and build long-standing relationships
  • Proven success collaborating with team members at all levels of the organization
  • Good sense of timing and the ability to recognize and solve problems
  • Ability to prioritize and allocate work actions based on importance, value, urgency and customer needs



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