Title: Claims TPA Oversight Lead

Company: Everest Advisors (Uk), Ltd.

Job Category: Claims

Job Description:

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.

What if I don’t meet every requirement? At Everest we are dedicated to building an inclusive and authentic workplace. So, if you are excited about this role but your past experience doesn’t align perfectly with every element in the job description, we still encourage you to apply. You may be just the right candidate for this or other roles. Please let us know if you need any accommodations throughout the application or interview process.

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 here 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

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Claims TPA jobs

Claims TPA Oversight Lead