Director, TPA Oversight

Company: The RiverStone Group
Location: Rockville Centre
Posted on: October 18, 2024

Job Description:

Description

Job TitleDirector, TPA OversightLocationRemote or Hybrid NH/NYSummary Reporting to the Head, P&C Claims, this leadership position is responsible generally for executing and delivering on the established goals and objectives of the Company and the P&C profit center and specifically for implementing the roadmap and vision for managing claims handled by third-party administrators with a heavy focus on Workers Compensation. Overall responsibility for the engagement and claim results produced by our third-party administrators. Duties include the leadership of TPA Oversight Managers in the management of third-party administrators including TPA selection, audit and review of compliance with contractual, legal obligations and other internal controls, assistance with TPA contract drafting and placement, preparation of special handling instructions, TPA fraud reporting, training and compliance, preparation of workflows to ensure accurate information exchange with TPA partners, and preparation and analysis of reports reflective of TPAs meeting key performance indicators, benchmarks and other obligations. The Director, TPA Oversight is also responsible for strategic initiatives relating to TPA Services including marketing functions, in alignment with the Company's Strategic Vision. Oversee the management of and participates in acquisition due diligences and the integration of acquired entities. Essential FunctionsResponsible for the results of TPAs engaged by the company. Communicate the results effectively with internal partners and senior management. Claim and transactional authority of $500,000 to $2,000,000 subject to the discretion of Senior Leadership. Determine financial authority framework for assigned area and provide financial authority on claims matters.Partner with the Head, P&C Claims and the Services Leadership Team to create and implement the mission and vision of the P&C profit center; to set goals for the P&C profit center; and implement overall strategic vision.Develops and maintains close relationships with clients and partners (external and internal), anticipating needs and immediately solving problems or concerns.Visible leader directing the development and mentoring of individuals and the implementation of strategic claim handling across multiple lines of complex claims. Collaborate with other RS Services leaders to align strategies across RiverStone's core insurance operations and with Business Operations, Digital Strategy and Corporate Operations to execute RiverStone's business objectives and strategies.Facilitate development of the Company's global strategies relating to Insurance Services, as well as account specific strategies, and inspire and equip teams to execute the strategies.Develop and implement claim handling protocols and procedures consistent with industry best practices and compliant with all legal and regulatory laws guiding the claim industry in all jurisdictions.Ensure that all claim liabilities within assigned area are handled timely, responsibly, professionally and prudently.Assess and report on progress in execution of strategy and on measurements of outcomes including the reporting of KPIs and goal progress. Drive continuous improvement.Embed a strong customer service focus into the organization and ensure the consistent delivery of superior customer service.Oversight of internal and external portfolios and claim reporting.Oversee preparation of coverage and claim analysis/reports.Ensure accurate payment of claims and estimation of claim exposures.Evaluate claims statistics to identify trends in claim activity and claim results and implement strategies to improve them. Work closely with Actuaries and Business Analytics and Operational Reporting to develop further metrics to measure claim results and progress. Monitor industry legislation, regulation, and case law developments to stay apprised of legal and regulatory changes.As assigned by Head of P&C Claims, take the lead position in Due Diligence projects and the integration of acquired entities.Represent the P&C Claims in cross functional projects. Serve on companywide committees as assigned.Perform work on specialty projects as assigned.Advance RiverStone and Fairfax objectives in inter-company and industry initiatives, committees, and conferences as well as in relationships with policyholders, affiliates, and other stakeholders.Leadership Essential Functions:Creates the environment such that innovative thinking is encouraged and fostered throughout the organization; takes ownership of innovation in their respective areas to ensure ideas are converted into business solutions; and encourages calculated risk taking and is willing to accept a reasonable degree of failure as a steppingstone to progress. Empowers associates to continuously improve processes and systems. Takes ownership of process improvement in his/her respective areas to ensure that ideas are implemented and continuously reviewed.Embed a strong customer service focus into the organization and ensure the consistent delivery of superior customer service.Visible leader responsible for communicating vision of unit/department/company for all projects and team assignments, ensuring that all team members understand desired outcomes.Facilitate and empower creativity of others, collaboratively transforming diverse creative ideas into strategic plans and seeing they are executed and measured.Exhibit a tremendous personal commitment to the Company, Department, Team, and Team members and operate with a "Company First" mentality by holding RiverStone's interests in the forefront of all actions and decisions made within scope of employment.Demonstrate alignment with RiverStone's Commitments. Model and practice RiverStone's Agreed Behaviors and Values.Supervise, monitor, mentor and/or leads direct reports. Seek out and deliver opportunities for Unit Managers and other associates to develop professional and leadership skills and qualifications; provide direct coaching, performance assessment and feedback to staff.; and evaluate assigned staff's performance and provide feedback to them and to the Chief Insurance Operations Officer.Establish and maintain effective working relationships with internal staff and external resources.Maintain a high degree of confidentiality.Participate in recruiting, hiring, mentoring and guiding Unit Managers and Claims Analysts. Partner with direct reports to meet deliverables timely.Relied upon as expert strategist with regard to complex challenges affecting the company's business. Prioritize and organize work in self-directed manner, handling or managing multiple assignments or projects simultaneously within established deadlinesRequired SkillsIn-depth knowledge of insurance concepts, principles, and strategies. Subject matter expertise in workers' compensation required.Ability to foster long lasting relationships with internal and external business partners.Litigation process and management knowledge required.Ability to analyze statistical reports, identify claims trends. Ability to communicate findings to executive leadership and create strategies for improvement. Leadership, including team development, goal setting, delegation, and project management.Computer skills and knowledge of database management software and application software (e.g.., MS Word, Excel, and PowerPoint).Effective organizational skills are required. Must be able to prioritize, handle and effectively delegate multiple assignments or projects simultaneously and meet established deadlines.Critical thinking and problem solving.High degree of business acumen.Able to identify, analyze and develop solutions for complex claim issues.Able to delegate tasks and follow up through delivery. Customer service oriented with the ability for developing long lasting relationships with internal and external business partners.Strong oral and written communication skills across all levels, with the ability to instill confidence through communication. Negotiation skills.Solid mathematical skills.Excellent interpersonal skills with an ability to interact with people at all levels of the organization.Effective communicator of vision, mission and strategy in group and individual contexts (Inspirational and motivating).ExperienceMinimum of 15 years of Workers' Compensation experience, including directly handling WC claims. Experience with high volatility and high severity losses.Liability claims experience a plus.Required EducationFour-year degree or equivalent business experience.Preferred Education or CertificationJD, CPCUSupervisory RoleDirectly supervises a unit of TPA Oversight Managers.TravelAs needed. Typically, 6-12 times per year.Work Environment / Physical DemandsThis position operates in a professional, collaborative environment and must have the ability to timely produce thorough, accurate work with many competing demands, deadlines, and distractions. The position uses standard equipment such as phones, computers, copiers/printers and filing cabinets. Noise level is moderate. Other Duties (Disclaimer Statement): RiverStone retains the right to change or assign other duties to this position as needed, or other duties or responsibilities may change or be assigned as needed.Core CompetenciesManaging and Measuring Work: Clearly assigns responsibility for tasks and decisions; sets clear objectives and measures; monitors process, progress, and results; designs feedback loops into work.Motivating Others: Creates a climate in which people want to do their best; can motivate many kinds of direct reports and team or project members; can assess each person's hot button and use it to get the best out of him/her; pushes tasks and decisions down; empowers others; invites input from each person and shares ownership and visibility; makes each individual feel his/her work is important; is someone people like working for and with.Perspective: Looks toward the broadest possible view of an issue/challenge; has broad ranging personal and business interests and pursuits; can easily pose future scenarios; can think globally; can discuss multiple aspects and impacts of issues and project them into the future.Developing Direct Reports and Others: Provides challenging and stretching tasks and assignments; holds frequent development discussions; is aware of each person's career goals; constructs compelling development plans and executes them; pushes people to accept developmental moves; will take on those who need help and further development; cooperates with the developmental system in the organization; is a people builder.Conflict Management: Steps up to conflicts, seeing them as opportunities; reads situations quickly, good at focused listening; can hammer out tough agreements and settle disputes equitably; can find common ground and get cooperation with minimum noise. Organizational Agility: Knowledgeable about how organizations work; knows how to get things done both through formal channels and the informal network; understands the origin and reasoning behind key policies, practices, and procedures; understands the cultures of organizations.Building Effective Teams: Blends people into teams when needed; creates strong morale and spirit in his/her team; shares wins and successes; fosters open dialogue; lets people finish and be responsible for their work; defines success in terms of the whole team; creates a feeling of belonging in the team. Problem Solving: Uses rigorous logic and methods to solve difficult problems with effective solutions; probes all fruitful sources for answers; can see hidden problems; is excellent at honest analysis; looks beyond the obvious and doesn't stop at the first answers.Process Management: Good at figuring out the processes necessary to get things done; knows how to organize people and activities; understands how to separate and combine tasks into efficient flow; knows what to measure and how to measure it; can see opportunities for synergy and integration where others can't; can simplify complex processes; gets more out of fewer resources.Integrity and Trust: Is widely trusted; is seen as a direct, truthful individual; can present the unvarnished truth in an appropriate and helpful manner; keeps confidences; admits mistakes; doesn't misrepresent him/herself for personal gain.Priority Setting: Spends his/her time and the time of others on what's important; quickly zeros in on the critical few and puts the trivial many aside; can quickly sense what will help or hinder accomplishing a goal; eliminates roadblocks; creates focus.Diversity, Equity, Inclusion & BelongingRiverStone Resources, LLC is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, LGBTQ+, national origin, gender identity, disability, protected veteran status, or any other characteristic protected by law.Privacy Notice for California Residentshttps://www.trg.com/california-consumer-privacy-notice/

Keywords: The RiverStone Group, Levittown , Director, TPA Oversight, Accounting, Auditing , Rockville Centre, New York