Claims TPA Oversight Lead

Everest; Greater London; On-site; GBP 65,000 - 85,000; Full time

Job summary

Everest is seeking a Claims TPA Oversight Lead in London to ensure the performance and quality of Third Party Administrators (TPAs) managing claims across multiple business lines. Responsibilities include developing oversight frameworks, conducting file reviews, and acting as a liaison between claims teams and vendor management. The ideal candidate should have strong claims experience, technical oversight abilities, and a degree in insurance or a related field. This full-time role emphasizes collaboration and continuous improvement in claims performance.

Qualifications

• Strong claims experience ideally in both insurer and TPA environments.
• Experience in technical oversight, performance monitoring, or audit.
• Ability to interpret data and translate insights into meaningful action.

Responsibilities

• Develop oversight frameworks across all referenced lines of business.
• Conduct comprehensive file reviews and QA assessments.
• Act as the link between Claims team and Claims Vendor Management.
• Prepare effective reporting on oversight activities for senior stakeholders.

Skills

Strong claims experience across relevant classes

Experience in technical oversight

Strong stakeholder engagement

Ability to interpret data

Education

Dip CII / ACII

Degree or equivalent experience in insurance

Tools

Guidewire

ECF

IMR

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.

Title: Claims TPA Oversight Lead
Company: Everest Advisors (Uk), Ltd.
Job Category: Claims

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 elevate 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

Essential

Skills, Experience & Competencies

• 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

• 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