TPA Audit Manager

Fortegra

(Jacksonville, Florida)
Full Time Travel Required
Job Posting Details
About Fortegra
As a leading provider of credit protection, insurance, warranty, and specialty underwriting products, Fortegra™ offers consumers relief from life’s inevitable setbacks. No matter the issue – from a lost cell phone to car trouble, appliance failures to job loss – we deliver unequaled value without forcing your customers to jump through the hoops typically associated with traditional insurance and protection programs.
Summary
The TPA Audit Manager will be responsible for performing assigned audit projects, as part of the overall internal audit plan approved by the VP Internal Audit and the CFO. Perform technical claim handling reviews for various insurance programs where the claim handling is done by third-party administrators (TPAs) or self-administering insureds. This responsibility will include: 1) evaluating existing control documentation, testing current processes and procedures and providing recommendations; 2) developing audit scopes; 3) performing audit procedures; 4) preparing third party audit reports reflecting the results of the work performed to include strengths, weaknesses, opportunities and potential threats within the current claim handling practices of the entity under review; and 5) timely identification and referral to management of issues that pose exposure to the Company.
Responsibilities
* Focus on the operations, financial and control processes associated with managing Third Party Administrators (TPAs) and Managing General Agents (MGAs) handling premiums and claims on the carrier's behalf. * Perform technical claim handling reviews and focus reviews for various insurance programs where the claim handling is done by TPAs or self-administering accounts. * Review and assess TPAs remittance and cash process. * Support finance and accounting in resolving aged accounting entries associated with TPAs. * Evaluate and determine TPA reserve requirements based on loss activity. * Monitor and report monthly leakage cost avoidance and savings in the TPA process. * Conduct annual TPA financial reviews as part of our due diligence process. Also conduct financial reviews of any newly requested TPAs. * Support TPA requirements for meeting carrier regulatory compliance, including state exams, audits and surveys. * Recommend process and policy improvements. * Follow up to ensure that approved recommendations are implemented. * Complete assigned audit procedures. * Summarize and communicate audit findings. * Prepare sufficient working paper documentation to support audit procedures performed and conclusions reached for assigned projects
Ideal Candidate
* Bachelor’s degree in Accounting or related business disciplines required * 5 - 10 years of experience auditing TPAs and GMAs required * Industry experience to include Warranty, Non-Standard Auto and/or Property & Casualty Insurance. * Statutory and GAAP Accounting experience a plus * Bilingual Spanish a plus * Basic knowledge of internal control concepts, internal auditing standards, COSO and risk assessment practices required. * Ability to conduct interviews with third parties using diplomacy and appropriate level of persistence. * Recognize patterns of adverse development, provide remedial action plans and refer promptly to the next level claim handler or claim management any file that exposes the company in excess of the policy retention. * Excellent written and verbal communication skills at all levels of the organization. * Proficiency with Microsoft Office applications. * Ability to work independently with limited required direction and guidance. * Ability to work in a confidential manner due to access to information of a sensitive nature. * Strong time management, problem-solving and analytical skills

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