Claims Program Manager

Who you are

• 5–8 years of claims handling or program oversight experience
• Experience working with TPAs, MGAs, or delegated authority programs preferred
• Strong understanding of claims fundamentals
• Familiarity with multi-state regulatory environments
• Strong analytical, organizational, and communication skills
• Proficiency in Microsoft Excel and claims systems
• Experience in program business or fronting carrier environment
• Exposure to reinsurance reporting
• Industry designations such as AIC, CPCU, or ARM preferred

What the job involves

• Reports To: Senior Claims Program Manager / Head of Claims, Spinnaker (Director, Claims-Partner Programs)
• The Claims Manager – Partner Programs is responsible for the day-to-day oversight and performance management of assigned programs and Third-Party Administrators (TPAs)
• This role ensures claims are handled in accordance with established guidelines, regulatory requirements, and service expectations while supporting strong claim outcomes and partner relationships
• Program Oversight & Execution
• Oversee claims handling for assigned programs to ensure compliance with claims guidelines, coverage intent, and regulatory requirements
• Monitor TPA performance including timeliness, reserving accuracy, and overall claim quality
• Conduct file reviews and QA audits to identify trends and improvement opportunities
• Assist in implementation and maintenance of claims guidelines and best practices
• Support onboarding of new programs including TPA setup, workflows, and reporting requirements
• Operational Support & Reporting
• Analyze claims data and KPIs to identify emerging trends and performance issues
• Prepare stewardship and performance reports for internal stakeholders and program partners
• Track and follow up on corrective action plans
• Support reinsurance reporting and documentation requirements
• Assist with regulatory audits, data calls, and compliance reviews
• Stakeholder Collaboration
• Serve as a primary point of contact for TPAs on routine matters
• Partner with underwriting, actuarial, finance, and legal teams
• Participate in program-level meetings and continuous improvement initiatives
• Professional Development
• Build expertise in coverage analysis, reserving, litigation management, and regulatory compliance
• Support senior team members on complex claims
• Participate in training and development opportunities

Benefits

• Healthy Hippos Benefits - Multiple medical plans to choose from and 100% employer covered dental & vision plans for our team members and their families. We also offer a 401(k) retirement plan, short & long-term disability, employer-paid life insurance, Flexible Spending Accounts (FSA) for health and dependent care, and an Employee Assistance Program (EAP)
• Equity
• Training and Career Growth - Training and internal career growth opportunities
• Flexible Time Off - You know when and how you should recharge
• Little Hippos Program - We offer 12 weeks of parental leave for primary and secondary caregivers
• Hippo Habitat - Downtown Austin, a 5-minute walk from the train station. Snacks and drinks available and catered lunches for onsite employees