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As the AVP of Corporate Claims you will provide Audit and oversight of TPA handling of claims in various lines of Commercial P& C business.

Key Accountabilities/Deliverables:

• Conduct regular audits of TPA claims handling processes to ensure compliance with company policies, industry regulations, and contractual obligations.

• Develop and maintain audit plans, checklists, and reporting tools tailored to the performance standards required by the organization.

• Identify and document performance issues, process gaps, and compliance violations; recommend corrective actions and track resolution progress.

• Monitor TPA adherence to service level agreements (SLAs) and claim resolution timelines.

• Evaluate the accuracy and appropriateness of claim payments, reserves, and denials made by the TPA.

• Collaborate with internal legal, compliance, and line of business claims teams to address complex or escalated claim matters involving the TPA.

• Coordinate the preparation of audit reports and executive summaries, including data-driven insights and actionable recommendations.

• Serve as the primary point of contact for communication and coordination with the TPA regarding audits, performance reviews, and corrective actions.

• Provide input on contract negotiations and renewal discussions with the TPA, ensuring terms support robust oversight and accountability.

• Stay current on industry best practices, regulatory changes, and emerging risks to inform ongoing TPA oversight strategy and audit methodology.

Technical Knowledge and Understanding:

• Ability to analyze complex claim files and identify inconsistencies, compliance issues, or deviations from best practices across multiple lines of insurance.

• Ability to communicate clearly and professionally with both internal stakeholders and external partners, including TPAs, regarding audit findings and performance expectations.

• Ability to interpret and apply insurance regulations, contractual obligations, and industry standards to real-world claim scenarios.

• Ability to manage multiple audits and oversight projects simultaneously, while maintaining accuracy, attention to detail, and adherence to deadlines.

• Ability to think critically and strategically when identifying process improvements, assessing risk exposures, and recommending corrective actions.

• Ability to maintain objectivity and confidentiality when reviewing claim files, conducting performance assessments, and handling sensitive information.

• Ability to adapt quickly to changing regulatory environments, business needs, and new lines of business or systems.

• Ability to use data and reporting tools effectively to monitor trends, evaluate performance metrics, and present findings in a clear and actionable format.

Experience:

• College degree required

• J.D. preferred

• A minimum of 5 years’ experience in the resolution of claims across multiple lines of business. Preferred lines include: General Liability, Excess Liability, NYLL, Commercial Transportation, Trucking, CD, Products Liability, Hospitality, Professional Liability (D& O and E& O), and Property.

Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa for this position.



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At Core Specialty, you will receive a competitive salary and opportunities for professional development and advancement. We offer medical, dental, vision, and life insurances; short and long-term disability; a Company-match of 100% of a 6% contribution 401(k) plan; an Employee Assistance Plan; Health Savings Account, Flexible Spending Account, Health Reimbursement Account, and a wellness program