Senior Claims Analyst: TPA Oversight & Data Insights

Clear Blue Insurance Group; Charlotte (NC); On-site; USD 80,000 - 120,000; Full time

Job summary

Clear Blue Insurance Group seeks a Senior Claims Analyst to manage complex commercial property and casualty claims through TPAs. You will monitor files, denials, reservations, and settlements, ensuring TPAs operate within authority and agreed processes.

You will collaborate with the CRO, Legal, Compliance, Finance, Underwriting, and IT to identify trends, report findings, and support data-driven decisions for program improvements.

Qualifications

• Bachelor’s degree in business, Finance, Risk Management, Insurance, or equivalent related experience.
• 5+ years of experience in claims analysis or a related role, preferably in a senior or lead capacity.
• 3+ years of experience in claim handling, relevant litigation, or TPA management.
• Industry certifications (e.g., AIC) preferred.

Responsibilities

• Provides front-line oversight of Third-Party Administrators’ personnel through direct communication and monitoring claims online using the Third-Party Administrators’ claim systems.
• Identifies, analyzes and discusses monthly loss run trends, reportable claims and/or problematic claims.
• Provides excellent claim service to external clients and internal partners.
• Participates in claim file reviews with agents, brokers and Third-Party Administrators’ claim personnel.
• Interfaces with Clear Blue and external underwriting on claim status, exposures, and other factors impacting their risks.
• Reviews and approves Third Party Administrators’ monthly claim handling fee.
• Prepares and presents internal management reports for large losses and large loss potential; usually over $250,000.
• Conducts remote and onsite claim file audits of Third-Party Administrators.
• Performs other duties as required by management including reinsurance and subrogation.
• The responsibilities of this position require continuous interaction internally (executive team, managers, supervisors, and fellow associates) and externally (with TPAs, managing general agents, reinsurers, and brokers/intermediaries).

Skills

Analytical skills

Problem-solving

Attention to detail

Excel

Data analysis

Claims systems

Written communication

Verbal communication

Multitasking

Cross-functional collaboration

Education

Bachelor’s degree in business, Finance, Risk Management, Insurance, or equivalent

Tools

Claims systems

Excel

Data analysis tools

Job description

Clear Blue Insurance Group seeks a Senior Claims Analyst to manage complex commercial property and casualty claims through TPAs. You will monitor files, denials, reservations, and settlements, ensuring TPAs operate within authority and agreed processes.

You will collaborate with the CRO, Legal, Compliance, Finance, Underwriting, and IT to identify trends, report findings, and support data-driven decisions for program improvements.