Claims TPA Oversight Lead

Title:

Claims TPA Oversight Lead Company:

Everest Advisors (Uk), Ltd.

Job Category:

Claims

Job Description:

About Everest:

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.

This is a great opportunity for someone currently in a Claims TPA oversight role, a Delegated Claims Analyst role or even a Claims Adjuster who wants to broaden their remit and move toward a more strategic, governance‑focused career path.

Role Purpose As the Claims TPA Oversight Lead, you will act as a key conduit between the Everest Claims team and the Claims Vendor Management function. You will oversee the performance and technical quality of TPAs managing claims across multiple classes of business, with a particular focus on A&H, Property & Casualty claims.

You’ll help ensure TPAs and Coverholders meet regulatory expectations, follow Delegated Authority (DA) guidelines, and submit accurate bordereaux and above DA referrals on time. This includes working closely with internal stakeholders to ensure operational alignment and  this role, you will support high technical standards, operational consistency, and continuous improvement across our International TPA and Cover holder panel.

Key Responsibilities Technical Oversight & Quality Assurance Develop and maintain technical oversight frameworks across all referenced lines of business

Conduct comprehensive file reviews, QA assessments, and root‑cause analysis

Provide technical guidance on complex claims, coverage interpretation, liability, and indemnity matters

Monitor reserving accuracy and indemnity spend, flagging trends and anomalies

Ensure TPAs remain within Delegated Authority levels and escalate issues where neededTPA & Cover holder Performance Management Act as the link between the Claims team and Claims Vendor Management, ensuring a cohesive approach to TPA and Cover holder oversight

Support TPA performance reviews, scorecards, governance meetings, and service delivery assessments

Work closely with the Claims Performance Manager (UK & Ireland) and the Vendor Management team to ensure timely bordereaux submissions and accurate referral handling

Identify performance gaps and assist with action plans and ongoing tracking

Support onboarding, transition, and exit processes for TPAs and Coverholders Data, MI & Reporting Analyse claims MI to identify trends, risks, performance issues, and leakage

Prepare clear, effective reporting on oversight activities for senior stakeholders

Liaise with the Global Claims QA team where appropriate

Stakeholder & Cross‑Functional Collaboration Work closely with Underwriting, Claims Quality Assurance, Legal, Actuarial, Finance, and Claims Operations Act as an escalation point for complaints, and technical challenges involving TPAsSupport internal and external audit requests relating to TPA oversight and quality assurance

Skills, Experience & Competencies Essential Strong  claims experience across relevant classes, ideally across both insurer and TPA environments

Experience in technical oversight, performance monitoring, or audit

Strong stakeholder engagement and influencing capability

Ability to interpret data and translate insights into meaningful action

Desirable

Experience with international TPA networks or cross‑border claims

Understanding of Lloyd’s, Wholesale, or London Market operating models

Experience in process improvement or project delivery

Familiarity with claims platforms (Guidewire, ECF, IMR)
Qualifications Dip CII / ACII preferred

Degree or equivalent experience in insurance, legal, or risk disciplines

Core Competencies Technical claims expertise across A&H and P&CStrong oversight and governance mindset

Analytical and detail‑focused

Collaborative and able to work cross‑functionally

Sound decision‑making skills

Customer‑focused with a commitment to fair outcomes

Strategic, solutions‑oriented thinking

Commer…