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Claims Third Party Administrator Service

80733

Job Summary

 

Zurich Insurance Plc (ZIP) is recruiting a Third Party Administrator (TPA) Service Specialist to join our GI Claims Team.

Reporting to the GI Claims Business Improvement Manager, the successful candidate will be responsible to oversee and monitor the delivery of a robust and effective control environment related to the provision of claims services provided by a TPA who manages a large and growing portfolio of motor damage and bodily injury claims.

This is an exciting opportunity for a career focused individual to gain experience in a varied and fast paced role.

Key Accountabilities

 

Key Accountabilities

 

Oversight

  • Implement and manage procedures, controls, and escalation processes to ensure the timeliness and accuracy of the TPA’s handling of motor damage and bodily injury claims.
  • Oversee claims which are outside the scope of the TPA’s claims handling authority and provide direction on setting of reserves, policy coverage. investigation strategies and settlement of claims.
  • Monitor claim reserves and where required prepare files for referral to the Zurich Reserve Committee. 
  • Monitor TNPS scores on all claims and provide the necessary feedback to stakeholders.
  • Manage & coordinate complaints to ensure complaints are investigated and resolved in line with Zurich Complaints Policy and, provide insight and analysis of all forms of feedback to ensure continuous improvement.
  • Assist in the scheduling, organization and conducting of TPA technical file leakage/quality, operational and other ad-hoc reviews to ensure compliance to regulatory, legislative, contractual and General Insurance Claims Policy (GICP) requirements.
  • Regularly audit damage and Injury files to establish application of timely, accurate and consistent reserves and ensure all files are reviewed on an on-going basis throughout the claims cycle   
  • Collaborate with new and existing TPA’s to ensure claims are managed in line with all regulatory and best practise standards.
  • Proactively work towards a system of continuous improvement around processes and procedures.
  • Adheres to the agreed Global Claims Vendor & TPA Management Best Practises.

 

Data Reporting

  • Develop and produce management reports and scorecards that will be utilized to improve the management and control of TPA’s.
  • Develop, implement, and manage processes for validating and reconciling TPAs' data fed into the Zurich systems to assure accuracy of funding, billing and compliance with all financial control requirements.
  • Contribute to projects and activities related to the maintenance and enhancement of the TPA’s data management and exchange processes.

 

Relationship Management

  • Manage and oversee resolution of performance issues.
  • Responsible for due diligence, technical guidance, and contract development on new and existing TPA’s.
  • Participate in performance review meetings with the TPA’s.
  • Building a rapport & relationship with new and existing TPA’s.
  • Liaising with both internal and external stakeholders and resolving all issues & queries.
  • Work closely with all stakeholders to identify and resolve potential problems at an early stage.
  • Provide insight to our internal stakeholders on the performance of the accounts under your management.
  • Support the Lines of Business heads by providing a highly credible claims proposition to our policyholders
  • Conduct analysis and closely monitor the TPA relationship value, including operational risks and escalate where appropriate.
  • Participate in ad-hoc project work that may present within the business.

 

Job Qualifications

 

Skills and Experience

 

  • A minimum of 5 years relevant claims handling experience, handling large portfolios of bodily injury claims.
  • CIP qualification required and ACII qualification desirable.
  • Must be accredited under the Minimum Competency Requirements.
  • Demonstrate an advanced standard of technical claims competence for handling moderate to high complexity bodily injury claims up to High Court level.
  • Possess strong policy language skills enabling accurate and consistent policy wording interpretation for coverage oversight
  • Knowledge and/or experience managing TPA’s a distinct advantage.
  • Experience in Managing Large Self-Insured Risks.
  • Excellent technical insurance knowledge.
  • Extensive experience in negotiation, particularly via attendance at Court.
  • A strong understanding of Governance & Oversight standards & requirements.
  • Ability to recognize, understand and adhere to appropriate legislative regulations.
  • Strong communication skills, both written and verbal and ability to demonstrate this effectively in relation to Managing external partners.
  • Excellent numerical and analytical skills.
  • Strong decision making and sound numeric skills.
  • Desire to learn and be flexible to business change.
  • To challenge the existing operating processes and improve upon them for the ultimate benefit of our customer.
  • To foster a culture of continuous improvement so that Zurich are recognised externally as being the best in class claims provider in the market.
  • Be solution oriented and able to demonstrate instances where they have been innovative in problem solving.
  • All employees are expected to work in accordance with the behaviours laid out in Zurich Purpose and Values.
     

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