Claims TPA Oversight Lead

Description

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About Everest:

Everest is a global leader in risk management, rooted in a rich, 50+ year heritage of enabling businesses to survive and thrive, and economies to function and flourish. We are underwriters of risk, growth, progress and opportunity. We are a global team focused on disciplined capital allocation and long-term value creation for all stakeholders, who care deeply about our impact on communities and the wider world.

This is a great opportunity for someone currently in a Claims TPA oversight role, a Delegated Claims Analyst role or even a Claims Adjuster who wants to broaden their remit and move toward a more strategic, governance‑focused career path.

Role Purpose

As the Claims TPA Oversight Lead, you will act as a key conduit between the Everest Claims team and the Claims Vendor Management function. You will oversee the performance and technical quality of TPAs managing claims across multiple classes of business, with a particular focus on A&H, Property & Casualty claims.

You’ll help ensure TPAs and Coverholders meet regulatory expectations, follow Delegated Authority (DA) guidelines, and submit accurate bordereaux and above DA referrals on time. This includes working closely with internal stakeholders to ensure operational alignment and compliance.

In this role, you will support high technical standards, operational consistency, and continuous improvement across our International TPA and Coverholder panel.

Key Responsibilities

Technical Oversight & Quality Assurance

• Develop and maintain technical oversight frameworks across all referenced lines of business

• Conduct comprehensive file reviews, QA assessments, and root‑cause analysis

• Provide technical guidance on complex claims, coverage interpretation, liability, and indemnity matters

• Monitor reserving accuracy and indemnity spend, flagging trends and anomalies

• Ensure TPAs remain within Delegated Authority levels and escalate issues where needed

TPA & Coverholder Performance Management

• Act as the link between the Claims team and Claims Vendor Management, ensuring a cohesive approach to TPA and Coverholder oversight

• Support TPA performance reviews, scorecards, governance meetings, and service delivery assessments

• Work closely with the Claims Performance Manager (UK & Ireland) and the Vendor Management team to ensure timely bordereaux submissions and accurate referral handling

• Identify performance gaps and assist with action plans and ongoing tracking

• Support onboarding, transition, and exit processes for TPAs and Coverholders

Data, MI & Reporting

• Analyse claims MI to identify trends, risks, performance issues, and leakage

• Prepare clear, effective reporting on oversight activities for senior stakeholders

• Liaise with the Global Claims QA team where appropriate

Stakeholder & Cross‑Functional Collaboration

• Work closely with Underwriting, Claims Quality Assurance, Legal, Actuarial, Finance, and Claims Operations

• Act as an escalation point for complaints, and technical challenges involving TPAs

• Support internal and external audit requests relating to TPA oversight and quality assurance

Skills, Experience & Competencies

Essential

• Strong claims experience across relevant classes, ideally across both insurer and TPA environments

• Experience in technical oversight, performance monitoring, or audit

• Strong stakeholder engagement and influencing capability

• Ability to interpret data and translate insights into meaningful action

Desirable

• Experience with international TPA networks or cross‑border claims

• Understanding of Lloyd’s, Wholesale, or London Market operating models

• Experience in process improvement or project delivery

• Familiarity with claims platforms (Guidewire, ECF, IMR)

Qualifications

• Dip CII / ACII preferred

• Degree or equivalent experience in insurance, legal, or risk disciplines

Core Competencies

• Technical claims expertise across A&H and P&C

• Strong oversight and governance mindset

• Analytical and detail‑focused

• Collaborative and able to work cross‑functionally

• Sound decision‑making skills

• Customer‑focused with a commitment to fair outcomes

• Strategic, solutions‑oriented thinking

• Commercial awareness

• Ability to work effectively in a matrixed environment

• Strong communication skills, both written and verbal

If you’re passionate about improving claims performance, strengthening vendor relationships, and ensuring exceptional customer outcomes, we’d love to hear from you.

Our Culture

At Everest, our purpose is to provide the world with protection. We help clients and businesses thrive, fuel global economies, and create sustainable value for our colleagues, shareholders and the communities that we serve. We also pride ourselves on having a unique and inclusive culture which is driven by a unified set of values and behaviors. Click to learn more about our culture.

• Our Values are the guiding principles that inform our decisions, actions and behaviors. They are an expression of our culture and an integral part of how we work: Talent. Thoughtful assumption of risk. Execution. Efficiency. Humility. Leadership. Collaboration. Inclusion and Belonging.
• Our Colleague Behaviors define how we operate and interact with each other no matter our location, level or function: Respect everyone. Pursue better. Lead by example. Own our outcomes. Win together.

All colleagues are held accountable to upholding and supporting our values and behaviors across the company. This includes day to day interactions with fellow colleagues, and the global communities we serve.

Type:

Regular

Time Type:

Full time

Primary Location:

London

Additional Locations: