TPA Claims Supervisor

TPA Claims Supervisor

Join to apply for the TPA Claims Supervisor role at USI Insurance Services
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Role can be worked remotely, ideally within New York State but will consider candidates throughout the New England region. Some travel to client sites required a couple times per month.

NYS Department of Finance Services - Casualty General Adjuster License required.

Supervise activities of 1 claim handler within the third‑party administration (TPA) claims handling department responsible for supervising, processing, paying and resolving Liability claims. Supervise staff, providing direction, setting goals, evaluating results and ensuring that overall staff goals are attained. Ensures that ongoing activities are performed according to established policies and procedures as well as applicable state regulations and specific carrier and client instructions.

Ensures that own work, as well as work of any employees supervised, is in compliance with applicable laws, regulations and guidelines, as detailed in policies.

• Supervise 1 claim handler including: hiring, training, career development, performance reviews and performance improvement plans.
• Supervise activities of claim handlers within the third‑party administration (TPA) claims handling unit responsible for supervising, processing, paying and resolving Liability claims according to established policies and procedures and applicable legal and regulatory guidelines.
• Supervise staff directly, providing direction, setting goals, evaluating results and ensuring that overall goals are attained. Provides leadership, coaching, counseling, training and guidance to staff and assigns responsibilities. Develops, assigns and monitors plans to ensure completion of goals and objectives and meeting deadlines. Ensures new staff members are trained in department policies, practices and procedures.
• Ensures adherence to policies, procedures, standards and guidelines. Coordinates compliance with overall division guidelines as well as regulatory agencies.
• Supervises ongoing claims activities, including receiving client claims, research and information gathering, clients and others as needed, payment determination and ongoing claims administration. Reviews claims files to ensure appropriateness of payments to clients, policy compliance and timeliness of work. Determines staff diary dates and reviews notes for active lost time claims. Ensures proper implementation of established policies and procedures.
• Visits clients regularly and maintains strong business relationships to exchange information and contribute to ongoing renewal of business. Communicates regularly with production and customer service areas to exchange account status.
• Assists staff with complex aspects of work as necessary. Resolves escalated issues and problems by conferring with staff, management, other internal departments, outside contacts and clients as necessary. Performs claims and other activities personally as workload requires.
• Manages scheduling and assignment of work and other activities to ensure that key deliverables meet established guidelines. Assesses internal and external customer needs and manages activities to ensure services are delivered in the most efficient way possible.
• Reviews and evaluates activities on a regular basis, ensuring that established policies and procedures are being followed. Provides management with regular updates on performance; takes corrective action as necessary.
• Maintains knowledge of current developments in the TPA claims industry, including regulatory issues and guidelines; alerts staff to developments and develops recommendations for consideration with division management in reviewing policies and procedures. Shares information with staff as appropriate.
• Participates in civic activities to promote growth and development of the community and a positive image for the Company.
• Participates in special projects and performs additional duties as required.
• Contributes to a positive, ethical and respectful working environment and communicates openly with others. Models Company culture both internally and externally.

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