RiverStone · 1 day ago
Manager, TPA Oversight
United States
Full-time
Remote
Senior Level
7+ years expRiverStone is a company that specializes in insurance solutions, and they are seeking a Manager for TPA Oversight. This role will be responsible for monitoring and coordinating the activities of third-party administrators handling multi-line commercial cases, with a focus on worker’s compensation claims.
Financial ServicesInsurance
Responsibilities
Coordinates TPA selection, review of compliance with contractual, legal obligations and other internal controls
Assists with TPA contract drafting and placement, preparation of handling instructions, TPA fraud reporting, training and compliance, preparation of workflows to ensure accurate information exchange with TPA partners
Responsible for all results of all assigned TPA oversight
Coordinates with TPA to develop KPI reports and other operational reports to manage the TPA towards those priorities
Reviews loss notices; confirms and interprets policy coverage; establishes accurate reserves; investigates and handles claims involving multi-line commercial cases; reviews reimbursement requests and initiates payment as appropriate
Consistently delivers superior customer service to both internal and external business partners
Develops creative ideas and solutions to real time business problems and /or business opportunities; Takes reasonable, calculated risks even if failure is possible
Ensures proper file setup, file documentation, reserving, general handling and application of company procedure and coverage interpretation
Conducts audits of TPAs; assesses claim handling performance of the TPAs and remedies issues as they arise; directs TPA activities
Participates in development of claim-handling techniques, including TPA oversight, defense coordination, expense control, and strategy
Reports on the results of TPA managed business and provides other claims information to senior management for selected losses and maintains specific financial and reporting metrics for reporting to management
Maintains diary control of reported cases to ensure maintenance of proper reserves to reflect the company's exposure and adequate notice to reinsurers, and recovery of specific amounts owed to the company, where applicable
Seeks continuous development by identifying areas for growth and improvement. Works with the continuous improvement team to implement process and technical improvements
Qualification
Required
Minimum of 7 years' experience of adjusting multi-line claims and worker's compensation claims, including large losses, preferably in multiple jurisdictions
Four-year college degree required or equivalent work experience
Preferred
Claims technical supervisory or management experience preferred
JD, CPCU, SCLA, CCLA
Company
RiverStone
We Deliver RiskSmart Run-Off(R) Solutions With Global Reach Aligning risk with the need for capital efficiency and greater business focus is a key challenge for insurers and reinsurers.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Debbie Irving
Executive Vice President & Chief Financial Officer
Bob Sampson
Executive Vice President, Chief Claims Officer at The RiverStone Group
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