Tpa Hr Solutions

Position Summary

The TPA Claims Oversight Manager oversees the end-to-end performance of Third-Party Administrator (TPA) claim operations for Property lines of business (e.g., flood, specialty property). This role ensures the TPA delivers timely, accurate, compliant, and customer-focused claim handling aligned to service level agreements (SLAs), best practices, and program objectives. The manager serves as the primary liaison between internal stakeholders, carriers and the TPA, driving quality outcomes, loss adjustment expense control, vendor performance, litigation outcomes (when applicable), and continuous improvement through analytics and operational governance. This role manages vendor performance and outcomes and does not include direct people management of internal claims staff.

Responsibilities

• TPA relationship & governance: Own the day-to-day partnership with assigned TPA(s), including operational cadence (weekly/monthly), issue escalation, and performance management against SLAs, KPIs, and contractual requirements.
• Claim quality oversight: Monitor indemnity and expense outcomes, reserving adequacy, coverage investigations, liability determinations, subrogation, and settlement strategy; ensure consistent application of best practices and claim authority.
• Compliance & regulatory adherence: Ensure claim handling meets jurisdictional requirements, fair claim practices, privacy/confidentiality expectations, and internal policies; coordinate audits and corrective actions.
• Litigation & complex claims management: Provide oversight of litigated, high-severity, and high-exposure claims; review defense strategy, counsel performance, budgets, and settlement posture; participate in mediations and roundtables as needed.
• Financial stewardship: Drive reserve accuracy, expense containment, and timely payment controls; review large payments and authority exceptions.
• Operational analytics & reporting: Produce and interpret dashboards and TPA reports (e.g., cycle time, diary/closure rates, leakage indicators, litigation rate, severity, subrogation recovery); identify trends and recommend actions.
• Audits & continuous improvement: Support TPA claim file audits (quality, technical accuracy, documentation) and translate findings into training, workflows, and remediation plans; track to closure where applicable.
• Process & program alignment: Ensure the TPA follows program-specific handling instructions, claim manuals, templates, and communication standards; update documentation as programs evolve.
• Stakeholder communication: Function as a point of contact for internal teams (Risk, Finance, Underwriting, Legal, HR, Customer/Client teams) and external clients as applicable; deliver clear status updates and recommendations.
• Vendor management: Oversee and influence the TPA’s use of property claim vendors (e.g., independent adjusters, field inspectors, appraisers, engineers, restoration contractors, estimating resources) and legal counsel as needed; validate panel adherence, outcomes, cycle times, customer experience, and cost controls.
• TPA capability & best-practice alignment: Partner with the TPA to ensure adjuster licensing/credentialing, property estimating competency, and adherence to handling guidelines; provide feedback on performance gaps and support remediation plans (without direct supervision of TPA staff).

Qualifications

• 5+ years of Property & Casualty claims experience, including oversight of complex/high-severity claims.
• 2+ years of leadership experience (formal people leadership and/or vendor/TPA oversight with accountability for outcomes).
• Experience managing TPAs, multi-state programs, or delegated authority arrangements.
• Demonstrated experience managing SLAs/KPIs, conducting claim file audits, and driving corrective actions.
• Strong working knowledge of claim best practices: coverage analysis, liability evaluation, reserving, negotiation, litigation management, subrogation, and expense control.
• Exposure to CAT, experience with property estimating platforms (Xactimate/Xactanalysis)
• Proficiency with claims systems, reporting tools and comfort working with dashboards/metrics.
• Strong written and verbal communication skills; ability to influence across internal and external stakeholders.

Education

• Degree in Business, Insurance, Law, or related field, or equivalent experience.
• Professional certifications (e.g., AIC, CPCU, MBA, JD, or equivalent) are a plus.

Additional Job Details:

The annual base pay range for this role is $145,000 - $175,000. This range reflects a good faith estimate of pay at the time of posting. Actual compensation will be determined based on factors such as experience, skills, knowledge, education, and internal pay equity.

About Tokio Marine Highland

Tokio Marine Highland Insurance Services (TMH) is a leading property and casualty underwriting agency. We offer a broad suite of tailored specialty risk management solutions, including private flood, fine art and lender-placed products. At TMH, it’s all about our clients. Nationwide, our customers rely on our trusted, industry-leading coverages, supported by compliance expertise, superior claims management and the highest caliber of service.

Founded in 1962, TMH is a wholly owned company of Tokio Marine Kiln, one of the largest carriers in the Lloyd’s of London insurance market and a member of the Tokio Marine Group. TMH has operating centers in Chicago, Il, Frisco, Texas, Miami, Fla., and South Pasadena, Calif.

If you’re looking to advance your career, TMH is the perfect professional home. At TMH, you’ll have a chance to innovate with the world’s leading businesses, put your expertise into action on major projects, and work on game-changing initiatives. You’ll also make long-lasting professional connections through sharing different perspectives, and you’ll be inspired by the best.

Tokio Marine Highland, LLC (TMH) is an Equal Opportunity Employer. TMH’s success depends heavily on the effective utilization of qualified people, regardless of their race, ancestry, religion, color, sex, national origin, sexual orientation, gender identity and/or expression, disability, veteran status, or any characteristic protected by law. As a company, we adhere to and promote equal employment opportunities for all.

Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is TMH’s policy to provide reasonable accommodation when requested by qualified individuals with disabilities during the recruitment process, unless such accommodation would cause an undue hardship. To make an accommodation request, please contact peopleandstrategy@tmhighland.com.