Claims Program Manager

As a Claims Program Manager, you will oversee claims operations and strengthen relationships with third-party administrators (TPAs), managing general underwriters (MGUs), and other business partners within a specialty insurance environment. You will lead and support a team of Program Management Specialists responsible for managing a diverse portfolio of claims clients. Your role will combine relationship management, operational oversight, risk assessment, and performance analysis to ensure claims are handled efficiently and in accordance with policy terms and regulatory requirements. Working closely with internal teams across Underwriting, Actuarial, Compliance, Legal, and IT, you will identify operational challenges and drive practical improvements. You will also contribute to team development, process documentation, and the delivery of consistent, high-quality service. This is an opportunity to make a meaningful impact on client partnerships and claims performance across a growing specialty insurance portfolio.

• Schedule, coordinate, and monitor annual client audits, acting as the primary audit coordinator.

• Review reports prepared by Program Management team members and provide first-level quality assurance.

• Oversee team members managing a diverse portfolio of products, administrators, and client relationships.

• Support a relationship-based service culture through regular engagement with clients and internal stakeholders.

• Act as a liaison between administrative, operational, and underwriting teams to resolve ongoing issues.

• Address sensitive or challenging customer situations professionally and constructively.

• Participate in team members' client meetings and ensure open issues are addressed at least monthly.

• Coordinate with IT to investigate and resolve technical or system-related issues.

• Assign or support the onboarding of new clients and administrative partners.

• Build long-term customer relationships through responsive and professional service.

• Support due diligence for prospective program administration partners, including onsite reviews and operational assessments.

• Participate in annual administrator reviews to verify compliance with company requirements and identify process gaps or improvement opportunities.

• Monitor claims activity at least quarterly to identify unusual trends or outliers.

• Identify processing, system, and operational issues affecting client or internal operations.

• Help ensure claims are processed and paid consistently with applicable policy terms.

• Prepare monthly reporting packages for senior management, including claims inventory, TPA customer service and turnaround statistics, and referral analysis.

• Analyze claims-related litigation and regulatory inquiries monthly to identify trends and potential exposure.

• Review claims referral logs at least quarterly and provide recommendations for potential adjustments to authority levels.

• Refer small claims litigation matters to the Legal team and provide assistance as needed.

• Review attorney correspondence and coordinate appropriate responses with administrators.

• Support the Compliance team in reviewing claims-related regulatory inquiries.

• Draft and maintain internal Claims Best Practices documentation covering company and regulatory standards, procedures, and workflows.

• Review and update documentation at least quarterly.

• Oversee the Program Management team's review of TPA best practices.

• Ensure claims administrators understand and follow applicable state unfair claims settlement practices laws.

• Continue developing the team's knowledge of relevant insurance products and claims processes.

• Help team members adopt a broader operational perspective beyond traditional claims auditing.

• Use real-world situations, including challenges involving administrators, as opportunities for coaching and professional development.

• Perform other related duties as assigned.

The ideal candidate combines specialty insurance claims experience with strong analytical, organizational, and relationship management skills. You should be comfortable managing multiple priorities, resolving complex operational issues, and communicating effectively with clients and internal teams. Required qualifications include:

• Bachelor's degree from an accredited university or equivalent professional experience.

• At least 6 years of relevant experience in Special Risk, Travel, and Travel Medical insurance.

• Strong proficiency with Microsoft Office applications, including Excel, Word, Outlook, and PowerPoint.

• Proven ability to build strong working relationships with customers, administrators, and colleagues.

• Demonstrated commitment to high-quality service delivery, customer satisfaction, and effective issue resolution.

• Strong analytical and problem-solving skills, with the ability to identify operational trends and implement process improvements.

• Excellent attention to detail and organizational skills, including the ability to manage multiple tasks in a fast-paced environment.

• Ability to work independently while contributing effectively to a collaborative team.

• Strong written and verbal communication skills, including the ability to explain complex information clearly.

• High level of personal accountability and commitment to continuous improvement.

• Willingness and ability to travel approximately 20%.

• Experience with specialty insurance products such as Employer Stop Loss, Travel, Short-Term Medical, Medical Travel, Workers' Compensation, and/or Occupational Accident.