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 claims governance specialist
Builds
Effective delegated claims framework operations and compliance
Domain
Insurance / Claims Management
Required skills
Governance oversight, Contract management, Risk monitoring, Due diligence, Audit coordination, Data analysis, Stakeholder liaison, Regulatory compliance
Preferred skills
Prior experience in claims, operations, or insurance roles
Technologies
Excel, PowerPoint, Management Information tools
Responsibilities
Support governance and oversight of all delegated claims arrangements, Maintain accurate records of DCA authorities and contracts, Monitor claims handling activities for adherence to service standards, Coordinate end-to-end onboarding for new DCAs and TPAs, Review completed onboarding questionnaires and supporting documentation, Conduct periodic reviews of delegated claims handlers, Track remediation actions from audits and quality reviews, Validate compliance with claims handling authorities and reporting requirements, Maintain Vendor Panel including oversight and fee structures, Facilitate quarterly peer review process in Audit Central
Seniority
Mid-Senior, hands-on IC
