The Opportunity

We are looking for an experienced claims leader to lead the strategy, governance, and performance of our third-party administrator (TPA) claim programs across multiple products, business segments, and jurisdictions.

This is a highly visible leadership role with responsibility for ensuring our TPA partners deliver fair, timely, accurate, and compliant claim outcomes while meeting our expectations for customer experience, financial performance, and operational quality.

You will serve as the senior business owner for key TPA relationships, lead a team of claims and vendor oversight professionals, partner closely with senior leaders across the organization, and influence how we manage outsourced claims operations at an enterprise level.

This role is ideal for a strategic P&C claims leader who knows how to balance technical claims expertise, vendor accountability, financial discipline, and strong relationships to drive results.

What You'll Do

Lead TPA strategy and governance

• Set the strategy, operating model, and governance framework for TPA claim programs across products, programs, jurisdictions, and business segments.
• Establish and continuously improve service-level agreements, performance scorecards, claim-handling guidelines, authority levels, escalation protocols, and reporting standards.
• Lead TPA selection, onboarding, implementation, renewal, transition, and termination activities while protecting claim continuity and customer service.

Own TPA performance and relationships

• Serve as the senior relationship owner with TPA leadership, leading business reviews, performance discussions, escalations, and negotiations.
• Hold partners accountable for claim inventories, cycle time, customer experience, claim quality, reserve adequacy, settlement accuracy, leakage, litigation activity, regulatory compliance, and contractual commitments.
• Assess TPA capacity, staffing, training, licensing, business continuity, data security, and catastrophe readiness, and drive action plans when risks emerge.

Provide senior claims leadership

• Provide strategic direction on complex, high-exposure, litigated, escalated, or disputed claims, including coverage, reserves, litigation strategy, and settlement approach within delegated authority.
• Lead the audit, calibration, and quality assurance framework for TPA claim handling.
• Identify performance trends and root causes and ensure corrective actions deliver sustainable improvement.

Lead and develop a high-performing team

• Lead, coach, and develop managers, claim consultants, relationship managers, and vendor oversight professionals.
• Build leadership capability and bench strength while creating a culture of accountability, sound judgment, collaboration, and continuous improvement.
• Set clear goals and expectations and ensure the team has the tools, resources, and direction needed to deliver results.

Drive enterprise partnership and improvement

• Partner with Legal, Compliance, Finance, Actuarial, Underwriting, Procurement, Operations, Technology, and business leaders on contracts, controls, data, reporting, systems, and service delivery.
• Develop and present performance dashboards, trend analysis, risk assessments, and strategic recommendations to senior and executive leadership.
• Lead continuous improvement initiatives across TPA processes, controls, technology, training, and operating models.

Manage financial performance

• Oversee department expenses as well as TPA fees, loss adjustment expenses, claim payments, reserves, vendor charges, and audit-related costs within delegated authority.
• Identify leakage and adverse financial trends, validate contractual billing and service outcomes, and drive corrective action.
• Establish financial performance targets and communicate results, trends, and risks to senior leadership.

What You'll Bring

Required Qualifications

• High school diploma or equivalent.
• 10+ years of claims or related P&C insurance experience, including experience with TPA, vendor, program, or outsourced claims oversight.
• 5+ years of progressive leadership experience, including leading managers or multiple teams.
• Adjuster licenses for applicable states, with the ability to obtain and maintain additional licenses as needed.
• Deep knowledge of claim investigation, policy interpretation, coverage analysis, reserving, litigation management, settlement practices, fraud indicators, regulatory requirements, and claims financial controls.
• Demonstrated experience establishing governance models, service levels, vendor performance standards, claims audit programs, and corrective action plans.
• Experience interpreting and negotiating contracts, statements of work, authority levels, fee structures, reporting obligations, and governance requirements.
• Demonstrated ability to influence senior internal stakeholders and external business partners and drive accountability without direct authority.
• Experience managing budgets and using operational and financial data to identify trends, determine root causes, and drive measurable action plans.
• Strong executive communication, presentation, negotiation, relationship management, and change leadership skills.

We'd Especially Like to See

• Bachelor's degree in business, insurance, risk management, finance, or a related field.
• Experience leading multiple TPAs, outsourced claim programs, complex vendor relationships, or multi-state claims operations.
• Experience with procurement, contract negotiation, vendor risk management, implementations, conversions, or TPA transitions.
• Professional insurance designation such as AIC, CPCU, or SCLA .
• Experience with claims analytics, dashboards, quality assurance programs, process improvement, or enterprise change initiatives.
• Experience presenting to senior and executive leadership and contributing to broader claims strategy.

What Success Looks Like

In this role, success means building a TPA operating model that delivers:

• Consistent, high-quality claim outcomes
• Strong regulatory and contractual compliance
• Improved cycle time and customer experience
• Appropriate reserves and settlement outcomes
• Reduced leakage and unnecessary expense
• Clear accountability across TPA partners
• Strong visibility into performance, risk, and financial results
• Continuous improvement in claims controls, technology, and operational effectiveness

Work Environment & Travel

This role operates in a fast-paced, highly regulated environment and involves managing multiple external partners, competing priorities, confidential claim information, and significant financial and operational accountability.

Travel may be required for TPA site visits, business reviews, audits, implementation meetings, and leadership sessions. Occasional schedule flexibility may also be necessary to support urgent claims issues, catastrophe events, regulatory deadlines, or other critical operational needs.