TPA Claim Manager - Heavy Equipment / Auto Liability
- Career Level
- Experienced (Non-Manager)
The TPA Claim Manager is the person accountable to HIIG for the performance of the TPA claim staff handling worker’s compensation claims on behalf of HIIG, its policyholders and insureds. The role is responsible for ensuring that the segment of claims under his/her purview are managed in accordance with HIIG claim handling requirements and standards, all applicable state and regulatory requirements, and meet or exceed HIIG’s expectations in the quality of the overall claim outcomes achieved.
The TPA Claim Manager oversees the handling of all heavy equipment transportation and auto liability claims, both claims that fall within the level of authority delegated to the TPA as well as claims that exceed that level of authority. The TPA Claim Manager reviews reserve increases, provides guidance and input on investigation, claims management activities, litigation management and reviews claims strategically for purposes of resolution. In addition, a key element of the role is the effective management of claim related expenses by ensuring the TPA’s compliance with use of HIIG preferred claims service providers, e g: investigators, attorneys, etc.
To oversee and direct the claim handling activities of TPA staff as may be necessary to ensure timely and appropriate claim investigation, effective management of the claim, adherence to claim handling requirements and practices, credible assessment of exposure reflected in case reserves, and prompt and fair resolution of the claim when and where possible.
- Manages relationship with Third Party Administrator staff handling the claims within his/her purview and ensures their understanding of HIIG claim handling requirements and performance expectations
- Directs the activities of the TPA and counsel providing input and direction as required.
- Conducts continuous review and oversight of claims managed by the TPA for purposes of:
- Ensuring that claims are handled effectively, evaluated quickly
- Case reserves appropriately reflect likely outcome
- Identifying any performance issues and compliance gaps and taking actions necessary to remediate.
- Actively monitors, manages and seeks to resolve claims that exceed the TPA’s delegated authority
- Ensures all open claims are effectively brought to resolution at the best possible outcome at the earliest opportunity.
- Identifies and evaluates additional opportunities to further reduce the severity and cost of claims
- Conducts analysis relating to understand the activity and ‘behavior’ of the claim population(s) under management and reports as required.
- Identify and pursue subrogation opportunities as they arise.
This TPA Claim Manager role requires a depth of heavy equipment transportation and auto liability claims ‘technical’ knowledge and experience in managing such claims subject to the regulations and requirements set forth by the State Authorities governing such matters in each State where the claim is domiciled.
- Minimum of 8 years of experience to include direct handling of Heavy Equipment Transportation and Auto Liability claims
- Some tenure in a supervisory or other leadership role managing claim handling staff
- Has demonstrated high level of understanding of individual state and civil laws, claims practices and regulatory requirements.
- Proven ability to direct and maintain a high level of claims management performance, quality and compliance.
- Strong analytical and organizational skills
- Excellent influencing and negotiation skills; proven ability to collaborate and build relationships across teams stakeholders and providers
- Flexibility to travel
- Able to manage, motivate and develop people
- Strong team building, influencing and negotiation skills
- Utilize specialized computer software applications. Document case histories, reports and letters
- Demonstrate effective written and verbal communication skills
- Evaluate and rate permanent disability cases
- Work independently and demonstrate good business sense
- Results oriented. A strong focus on execution and getting things done right.
- A self-starter with a high level of professional maturity and a strong sense of urgency
- Comfortable and effective working in an entrepreneurial environment.
- Thrives on and is not afraid of challenges
- Ability to establish and maintain effective working relationships with peers, staff and other functional areas.
- Ability to identify and develop talent, delegate clearly and appropriately
- Ability to drive results by identifying and resolving significant problems within the scope of responsibility
Bachelor Degree Required
Certifications: Associate in Risk Management; Claim Management or other related industry designation
Licenses: Current state adjusting license, a plus.