Manager, TPA Oversight
Location
United States
Posted
54 days ago
Salary
0
Seniority
Lead
No structured requirement data.
Job Description
Manager, TPA Oversight
Riverstone Resources
Role Description This role will be responsible for monitoring, reviewing, and coordinating the activities of TPAs handling multi-line commercial cases with an emphasis on worker’s compensation claims including: - Analyzing coverage issues - Establishing accurate reserves - Resolution of cases on behalf of affiliate insurers - Oversight of TPA selection - Audit and review of compliance with contractual, legal obligations and other internal controls - Assistance with TPA contract drafting and placement - Preparation of special handling instructions - TPA fraud reporting - Training and compliance - Preparation of workflows to ensure accurate information exchange with TPA partners - Preparation and analysis of reports reflective of TPAs meeting key performance indicators, benchmarks and other obligations Essential Functions: - Coordinates TPA selection and compliance review - Assists with TPA contract drafting and placement - Responsible for all results of assigned TPA oversight - Coordinates with TPA to develop KPI reports and other operational reports - Reviews loss notices and confirms policy coverage - Establishes accurate reserves and investigates claims - Delivers superior customer service to internal and external partners - Develops creative solutions to business problems - Ensures proper file setup and documentation - Conducts audits of TPAs - Participates in development of claim-handling techniques - Reports on TPA managed business results to senior management - Maintains diary control of reported cases - Seeks continuous development and improvement Qualifications - Minimum of 7 years’ experience adjusting multi-line claims and worker’s compensation claims, including large losses, preferably in multiple jurisdictions - Claims technical supervisory or management experience preferred - Experience analyzing statistical reports of multi-line claims and identifying trends Requirements - Four-year college degree required or equivalent work experience Preferred Education or Certification - JD - CPCU - SCLA - CCLA Travel - Minimal to moderate, based upon business needs Work Environment / Physical Demands This position operates in a professional, collaborative environment and must have the ability to: - Timely produce thorough, accurate work with competing demands and deadlines - Use standard equipment such as phones, computers, copiers/printers, and filing cabinets - Work in a moderate noise level environment Diversity, Equity, Inclusion & Belonging RiverStone Resources, LLC is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, LGBTQ+, national origin, gender identity, disability, protected veteran status, or any other characteristic protected by law. Privacy Notice for California Residents Privacy Notice for California Residents
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