Claims Program Manager

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Claims Program Manager based in the United States.

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.

Accountabilities

In this role, you will oversee program claims activities, support the development of the Program Management team, and ensure strong operational relationships with administrators and business partners. Your responsibilities will include:

• Relationship Management

• 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.

• Risk Management

• 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.

• Reporting and Trend Analysis

• 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.

• Legal and Regulatory Coordination

• 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.

• Best Practices and Process Documentation

• 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.

• Training and Development

• 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.

Requirements

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…