AVP, TPA Claims

At Coaction, we’re a unique mix of leaders, achievers, thinkers, and team players with a high-performance mindset and a diverse skillset. We bring our industry expertise together to continually push the boundaries of what insurance can be for our clients.

At Co/Action, we’re a unique mix of leaders, achievers, thinkers, and team players with a high-performance mindset and diverse skill set.  We bring our industry expertise together to continually push the boundaries of what insurance can be for our clients.

We are seeking an AVP, TPA Claims to join our Third-Party Administrator (TPA) Claims Team in either our Morristown, New Jersey, Glendale, California or New York City location. The TPA Claims AVP will be responsible for the day-to-day management of the internal TPA team assisting in all aspects of the claim operation for the TPA programs and operations.  The AVP of TPA Claims is responsible to develop and oversee TPA program protocols and guidelines and this role will also support the development of our claims department by providing strategic insight and identifying areas of improvement throughout the business while conducting training and support on complex claims issues.

Key Responsibilities:

• Oversee and manage the internal TPA claim management team and the claim inventory for TPA partners across multiple lines, including auto, workers' compensation, property, and legacy claims.
• Develop, implement, and enforce claims handling protocols and best practices to ensure high-quality service and outcomes across TPA programs.
• Cultivate and maintain strong relationships with underwriters and brokers to tailor claims-handling approaches to meet client needs.
• Ensure TPA compliance with coverage evaluations, authority levels, staffing metrics, and litigation management; monitor prompt, quality investigations, timely reserving, and claim resolutions.
• Oversee the tracking and evaluation of TPA performance through onsite or virtual operational and best practice audits, coordination with Co/Action technical claim audit team and TPA key claim performance metrics.
• Oversee TPA remediation activities/action plans as necessary to address performance.
• Collaborate with business units to identify and mitigate risks associated with third-party vendors while exploring opportunities for improvement.
• Work with Underwriting and Program Managers (MGA’s, MGU’s) to secure renewals and new business opportunities for “unbundled business” through the use/approval of TPAs.
• Prepare and maintain documentation for TPAs, including contracts, policies, procedures, and reporting protocols.
• Recruit and develop quality staff, setting goals and objectives aligned with the corporate strategy.
• Conduct training sessions on third-party risk management programs and policies to ensure firm-wide compliance and understanding.
• Work closely with the Legal department to effectively manage contracts with third-party vendors.
• Prepare and deliver monthly and quarterly management reports and metrics to senior leadership.
• Monitor and control departmental expenses while balancing staff caseloads.

QUALIFICATIONS:

• 10 years of experience in Claim Management.
• 5-7 years of TPA management experience.
• Bachelor’s degree preferred
• Strong claims and claims operational background.
• Strong understanding of the insurance industry/market
• A record of providing outstanding claim service and customer service experience
• Excellent verbal and written communication skills with strong influencing communication skills
• Experience in conflict resolution and strong negotiation skills
• Results oriented, and ability to think strategically.
• Excellent organizational skills and flexibility managing and tracking projects.
• Enthusiastic, reliable, and collaborative leader.
• Strong focus on problem solving and demonstrated commitment to teamwork/team development
• Experience leading and influencing others through change
• Demonstrates leadership skills to manage and drive solutions
• Relationship/Partnership/Account management background – a plus
• Proficiency with MS Office software, Excel and PowerPoint
• Strong verbal and written communication skills
• Familiarity with contract management and legal aspects of vendor relationships is a plus.

* *This is not available as a fully remote employment. Interested candidates must be willing to work on a hybrid work schedule**

Equal Opportunity Employer

Coaction is an Equal Employment Opportunity employer. Coaction’s policy is not to discriminate against any applicant or employee based on race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, and genetic information, or any other basis protected by applicable law. Coaction also prohibits harassment of applicants or employees based on any of these protected categories.

If your application is selected, you will receive an email directly from the Coaction Recruiting Team at [email protected] asking you to contact a member of the Coaction Recruiting Team. Any other method of contact may be fraudulent.