Delegated Claims Specialist
Core
Oversight, governance, and performance management of Delegated Claims Administrators (DCAs), Third Party Administrators (TPAs), and Coverholders to ensure compliance with internal guidelines, regulatory requirements, and contractual obligations.
Role type
Senior IC delegated claims governance specialist
Builds
Effective delegated claims framework operations and compliance adherence
Domain
Insurance / Claims Management / Regulatory Compliance
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Delegated authority claims management, Contract oversight, Vendor management, Audit coordination, Risk monitoring, Stakeholder liaison, Data analysis, Compliance validation
Preferred skills
Prior claims or operations experience, Insurance industry knowledge
Technologies
Excel, PowerPoint, Management Information tools
Responsibilities
Maintain accurate records of DCA authorities, contracts, and onboarding documentation; Monitor claims handling activities to ensure adherence to service standards; Coordinate end-to-end onboarding and due diligence reviews for new DCAs and TPAs; Review Management Information, audit findings, and service metrics; Validate compliance with claims handling authorities and reporting requirements; Build relationships with external partners and internal teams (Claims, Underwriting, Compliance, Legal, Finance).