Claims TPA Regulatory Governance and Performance Manager - American International Group

At AIG, we are reimagining the way we help customers to manage risk. Join us as a Claims TPA Regulatory Governance and Performance Manager to play your part in that transformation. It’s an opportunity to grow your skills and experience as a valued member of the team.

Make your mark in Claims

Our Claims teams are the proven problem solvers of choice for clients, delivering consistent technical excellence and showcasing our service differentiation to create an unparalleled global claims handling experience. Through a robust stakeholder feedback loop and supported by consistent processes and leadership, we take pride in delivering responsive, fair and professional service with empathy and efficiency.

Why Claim Third Party Governance Matters:  AIG uses a vast network of third parties to support its global business operations and manage risk.  Risk created by third parties is one of the top ten operational risks at AIG.  As Contract Owners, we have an active, hands-on role in managing a third party for the entire governance lifecycle. The Third Party Administrators (TPAs) Claims Governance Team is the contract/segment owner for TPAs within the U.S., Canada and LAC.  We partner with many business units/control groups to ensure that the minimum requirements established for how the Company manages third parties to ensure alignment with regulatory requirements and to minimize risks are executed.  We have oversight responsibility for TPAs, which includes the vetting, approval and onboarding of new TPAs for the acquisition of new and renewal business by our Underwriting partner.  For existing, approved TPA arrangements, oversight encompasses ongoing governance, due diligence and performance monitoring/management of TPAs handling hundreds of thousands of reported claims annually on behalf of AIG and its clients.  The approved TPAs handle multiple lines of business for both Commercial and Personal Insurance and are predominately Insured/Client selected.   

How you will create an impact

This position will ensure that Third Party Administrators (TPAs) provide high quality claims management and State Regulatory compliance performance in the various states and venues, with a heavy emphasis in Worker’s Compensation.  This role is responsible for identifying and mitigating AIG’s risk related to third party administrators by ensuring effective State Regulatory and Compliance controls and oversight strategies are in place and consistently executed. 

This position reports to the Claims Head of TPA Governance/Third Party Management for General Insurance.

Your Contribution at AIG as a TPA State Regulatory Performance Manager:

As a Leader within the TPA Claims Governance team and an influencer at AIG, people come to you as a “go-to” source and support because of your deep knowledge of the claims operational/technical processes and the AIG/TPA business relationship.  You balance the needs of multiple stakeholders, making sound decisions, utilizing your claims, workers’ compensation, regulatory experience, judgment, and risk mitigation mindset.  Ultimately, you take ownership for key outcomes, and you are the one both internal and external partners turn to for issue resolution/direction related to TPA claim and state regulatory matters.  You act with speed, composure, an AIG/Client focus with an unwavering commitment to deliver solutions.  The work you do every day is the heart of AIG’s business partnerships. 

The ideal candidate will have Claims Management/Leadership and Claims Technical level experience, preferably within Workers’ Compensation. This role will be responsible for leading/managing a team of compliance/state regulatory professionals and should have significant/deep experience managing multiple projects, high-level, complex tasks at once with proven success in delivering and completing all timely, fully, accurately and within the requested or established timeframes often set by the various state and regulatory agencies.  The individual must have significant experience with Workers' Compensation as a Claims Manager/Director (managing a team of Claims Professionals with wide-ranging state regulatory/claims handling responsibilities) as State Regulatory projects (i.e. State Regulatory Audits, California SIU/Fraud Audits, Workers’ Compensation post project/handling reviews, etc.) must be strategically managed on behalf of AIG for more than 50-60 TPAs, in close partnership with internal AIG Claims and Claims Legal. This individual should have experience working with internal AIG Workers' Compensation processes/procedures and have an excellent understanding of the current regulatory environment.   Duties will also include training and developing claim professionals/analysts;evaluating/maintaining team performance metrics, etc.  You will interface with critical stakeholders/external business partners to resolve issues and support Claims TPA Governance business initiatives. Responsibilities include:

• Ensure compliance with AIG’s Global Third Party Risk Management Policy and Standards.
• Oversee the day-to-day operations of the TPA Governance State Regulatory team (est. 6-8 FTEs).
• Provide direction, guidance, and professional development to direct reports and ensure appropriate succession plans are in place.
• Lead, direct, manage and continuously evaluate the work flow/processes and assignments of the team for high efficiency.
• Coordinates work activities to achieve the expected claims/state regulatory operational outcomes/goals across all TPAs.
• Recognize and recommend Claims TPA Governance operational improvements to drive efficiency and cost mitigation.
• Provide proactive oversight/management of State Regulatory Compliance for all Third Party Administrators (TPAs).
• Lead State Regulatory efforts ensuring resources are appropriately and efficiently assigned to monitor regulatory adherence.
• Identify and implement various means to improve state regulatory risk monitoring/oversight.
• Support organizational efforts to mitigate exposure to fines/penalties as measured in penalty occurrences/dollars of TPAs.
• Establish and maintain appropriate means to monitor and accommodate changes in the state regulatory environment that impact
• AIG’s state regulatory obligations, which are heavily impacted by TPA usage/performance.
• Monitor existing TPA operational control structures and ensure necessary changes to controls are made based upon audit feedback    (self-audits, state agency/Workers’ compensation board audits, PwC audits).
• Foster working relationships with state regulatory bodies, AIG Claims/Legal in furtherance of AIG state regulatory compliance efforts.
• Assist with due diligence requirements for TPA onboarding to include onsite competency evaluations as needed.
• Partner with Contracts Director/Claims Legal to address any/all State Regulatory/Compliance issues.
• Serve as an escalation point of contact for all TPA State Regulatory issues that put the AIG customer/client experience at risk.
• Communicate and/or educate TPAs regarding applicable AIG claims state regulatory procedures and claim handling expectations.
• Proactively, continuously evaluate and drive improvement of TPA performance with State Regulatory/Compliance claims handling.
• Own/develop & monitor remediation activities/action plans at a TPA level related to State Regulatory performance.
• Ensure communication/feedback loop to business partners/stakeholders on material changes/issues with TPAs that may affect the relationship specific to State Regulatory performance/fines/penalties, etc. and any reputational risk associated with same.
• Conduct and/or participate in required annual TPA onsite operational audits (bi-annual/annually) for operational/technical fitness.
• Ensure the development/management of Action Plans as a result of state regulatory/agency or technical audit deficiencies, etc.
• Ensure all TPAs make State Regulatory Compliance a priority through their internal practices, performance and responses.

What you'll need to succeed

• 7+ years of experience in Claims Leadership/Management/Technical Claims Handling – Workers’ Compensation a plus.
• Bachelor’s degree preferred.
• Strong claims, claims technical and operational background. 
• Strong understanding of the insurance industry/market and regulatory environment.
• A record of providing outstanding claim service and customer service experiences.
• Excellent verbal and written communication skills with strong influencing communication skills.
• Experience in conflict resolution, or the ability to de-escalate tense situations - comfortable in a role that requires negotiation.
• Analytical skills, resourceful with the ability to search and find answers/market data as needed.
• Results oriented, measurement focused and more than able to lead independently and work/succeed well under pressure.
• Excellent organizational skills – very flexible with moving from project to project while keeping track of progress.
• Demonstrates a high level of interpersonal skills; skilled at relationship building.
• Strong focus and demonstrated commitment to team work/team development.
• Experience leading and influencing others through change and ever increasing accountability and responsibilities.
• Demonstrates strong leadership understanding / skills to manage and drive solutions.
• Ability to self-start, lead and develop self-starters who are able to work independently and consistently meet deadlines.
• Strong problem solving skills/proven capability to develop and implement solutions.
• Proficiency with MS Office software, including Access, Visio, Excel and PowerPoint.

Ready to take your career to the next level?  We would love to hear from you.

#LI-AIG #claimsprofessionals #legalcareers #tortlaw #claims #claimsexaminer #claimsadjuster

Enjoy benefits that take care of what matters

At AIG, our people are our greatest asset. We know how important it is to protect and invest in what’s most important to you. That is why we created our Total Rewards Program, a comprehensive benefits package that extends beyond time spent at work to offer benefits focused on your health, wellbeing and financial security—as well as your professional development—to bring peace of mind to you and your family.

Reimagining insurance to make a bigger difference to the world

American International Group, Inc. (AIG) is a global leader in commercial and personal insurance solutions; we are one of the world’s most far-reaching property casualty networks. It is an exciting time to join us — across our operations, we are thinking in new and innovative ways to deliver ever-better solutions to our customers. At AIG, you can go further to support individuals, businesses, and communities, helping them to manage risk, respond to times of uncertainty and discover new potential. We invest in our largest asset, our people, through continuous learning and development, in a culture that celebrates everyone for who they are and what they want to become.

Welcome to a culture of belonging

We’re committed to creating a culture that truly respects and celebrates each other’s talents, backgrounds, cultures, opinions and goals. We foster a culture of inclusion and belonging through our flexible work arrangements, diversity and inclusion learning, cultural awareness activities and Employee Resource Groups (ERGs). With global chapters, ERGs are a cornerstone for our culture of inclusion. The diversity of our people is one of AIG’s greatest assets, and we are honored that our drive for positive change has been recognized by numerous recent awards and accreditations.

AIG provides equal opportunity to all qualified individuals regardless of race, color, religion, age, gender, gender expression, national origin, veteran status, disability or any other legally protected categories.

AIG is committed to working with and providing reasonable accommodations to job applicants and employees with disabilities.  If you believe you need a reasonable accommodation, please send an email to candidatecare@aig.com.  

Estimated Travel Percentage (%): No Travel

Relocation Provided: No

AIG Claims, Inc.