Consultant, TPA Management

Description

The Consultant, TPA Management will be responsible for supporting administration of Third Party Administrator (TPA) providers for unbundled programs within GRS, developing effective relationships with providers, creating alignment across internal stakeholders and reviewing and enhancing processes, procedures and controls to ensure consistent execution of unbundled programs.  This position will be heavily involved in data quality efforts with our TPA partners: enabling new data connections, partnering to resolve existing data issues, and working toward more efficient data processes.

 

If the selected candidate lives within 50 miles of a GRS NA Claims office, then an in-office presence of two times/month is required. This policy is subject to change. If outside of a 50 mile radius from a GRS office, the selected candidate can work fully remote.

 

Responsibilities

• Lead efforts with our TPAs around data quality.
  • Assist with data integration setup for new partner TPAs.
  • Support efforts to expand our automated data ingestion processes with the TPA business.
  • Work with partner TPAs to address issues with data quality and resolve any items requiring correction by the TPA.
  • Track and report on data quality performance of our partner TPAs through defined processes.
• Participate in the due diligence process for approval and onboarding of assigned new TPAs
  • Ensure required documents and responses are received from the TPA and are triaged to appropriate stakeholders
  • Engage GRS Systems and Claims stakeholders upon approval to ensure timely onboarding of TPA provider
• Participate in negotiating amendments to master service agreements between Liberty Mutual and our partner TPA providers; resolve any issues to ensure timely execution of all amendments
• Coordinate with NI Casualty account teams (underwriting, distribution, service and claims) for onboarding of assigned new business
• Manage notification to internal stakeholders and execution of service level agreements
• Support compliance reviews of TPA providers, escalating issues as needed to drive prompt resolution
• Evaluate internal and regulatory audits of TPA providers
• Resolve any assigned service issues that may arise concerning the TPA providers. Engage internal groups such as GRS Systems, GRS Claims, Support Services, Financial and Regulatory Reporting as needed to ensure issues are thoroughly investigated, triaged and resolved
• Support activities related to the transition of claims administration between TPA providers for existing customers, including coordination of notifications to State agencies and regulatory boards
• Maintain effective relationships with all TPA partners. Meet regularly with TPA contacts to discuss performance, solicit feedback, drive innovation and ensure compliance with regulatory changes
• Ensure adequate documentation of processes and controls including updates to reference documents and training content
• Develop insight into TPA performance to drive underwriting decision-making
• Oversee handling of daily administrative activities (e.g. state data requests and inquiries)
• Coordinate requests for ad-hoc projects, including data for risk control analysis.

Qualifications

• High level of understanding of commercial casualty products and insurance operations
• Working knowledge of third-party administration marketplace and regulatory environment required
• Experience in employee development, succession planning and managing operational performance
• Skills required include communicating effectively, negotiation, influencing others, decision making, executing well, planning and organizing work and achieving results
• Skills and knowledge as normally acquired through a minimum of 6 years of experience in any combination of underwriting, distribution and/or service management
• Bachelor`s degree required

Travel

10%