Company Description

upcover is a CBInsights 2025 top 50 global insurtech, and a Specialty & SME commercial lines platform operating in Australia's $20B+ insurance market down under. The company operates as a digital MGA and an AI-native broker, trusted by 70,000+ businesses and accessing 50+ insurers.

upcover specializes in simplifying insurance distribution, enabling trusted brands, online businesses, and marketplaces to offer affordable SME insurance solutions. With a focus on innovation, upcover is committed to providing fast, accessible, and efficient insurance services that cater to the needs of businesses across various industries.

Role

As Claims Manager, you will be responsible for working within our EIS digital underwriting business and supporting our claims advocacy team within our upcover digital underwriting business. This will mean overseeing our commercial motor fleet claims portfolio, including supervision of our claims Third Party Administrator (TPA), with our valued brands and distribution partners and our upcover digital broking business claims advocacy work with our more than 50 insurance partners. This is a hands-on role requiring deep motor (and possibly other product lines) claims expertise, strong analytical skills, and the ability to ensure our TPA, brands and upcover and EIS teams deliver exceptional outcomes for our clients. Important to success is ensuring that we build the team, processes and reporting frameworks to supervise and ensure that all claims are managed efficiently, fairly and transparently for all customers.

You will be the internal authority on claims advocacy, and motor claims performance, responsible for monitoring quality, driving efficiency, and identifying opportunities to improve both client experience and portfolio outcomes across our EIS digital underwriting business and upcover digital broking business.

Key Responsibilities

TPA & Distribution partners Supervision & Governance

• Provide oversight of the claims TPA and our distribution partners, ensuring adherence to service level agreements, claims handling standards, and regulatory obligations
• Act as the primary escalation point for the TPA on complex, disputed, or high-value claims
• Serve as the key liaison between the TPA and our insurance partner ensuring alignment on claims decisions, coverage matters, and performance expectations
• Conduct regular file reviews and quality assurance audits to assess claims handling quality, reserving accuracy, and compliance
• Perform QA reviews of TPA and distribution partners to ensure data integrity, accurate claims recording, and process compliance
• Manage the TPA relationship including regular performance meetings, escalation management, and issue resolution
• Ensure TPA and distribution partner compliance with claims handling obligations under the AFSL and binder arrangements
• Review, approve and escalate if necessary to our insurance partner authority limit referrals and coverage decisions as required

Claims Performance & Analytics

• Monitor our TPA’s monthly reporting including key claims metrics including:
• Claims frequency (per vehicle / per $1m premium)
• Average claim cost by claim type (own damage, third party property damage, theft, windscreen, fire)
• Claims lifecycle times (notification to assessment, assessment to settlement)
• Repair costs (average repair cost, parts vs labour split, preferred repairer utilisation)
• Total loss ratios and salvage recovery rates
• Reserve adequacy (initial reserve vs final paid analysis)
• Identify trends, emerging risks, and areas of leakage or inefficiency
• Monitor claims and complaints trends to identify potential product performance issues and contribute insights for product review
• Adapt TPA reports for EIS own claims performance reporting for internal stakeholders and insurer partners
• Contribute to portfolio pricing and underwriting discussions with claims insights
• Identify and address sources of claims leakage including over-payments, inefficient repair processes, and missed recovery opportunities and implement proactive recommendations for improvement with distribution partners
• Oversee subrogation and recovery processes to maximise third party and uninsured loss recoveries

Claims Advocacy Support & Claims Escalation

• Support the digital broking business claims advocacy team at upcover as for handling and reporting to insurance partners claims and notifications of incidents.
• Work with the TPA and insurer partner to resolve coverage disputes and achieve fair outcomes.
• Monitor customer feedback on claims experience and identify opportunities to improve service delivery within the claims advocacy team.

Compliance & Continuous Improvement

• Ensure claims processes comply with relevant regulatory requirements including the General Insurance Code of Practice and AFSL obligations
• Track and analyse claims-related complaints to identify systemic issues, root causes, and trends that may indicate product or distribution concerns
• Provide claims and complaints data and insights to support DDO product reviews and TMD assessments
• Identify opportunities to improve claims processes, TPA performance, and client experience
• Contribute to development of claims policies, procedures, and service standards
• Support complaints and IDR processes related to claims matters

About You

Essential Experience & Qualifications

• Minimum 5 years' experience managing commercial motor claims, including motor fleet insurance
• Experience developing, implementing, or improving claims procedures, workflows, and service standards
• Proven ability to identify process inefficiencies and implement improvements to enhance claims outcomes
• Strong understanding of motor claims lifecycle including assessments, repairs, total losses, and recoveries
• Experience with claims data analysis and performance reporting, including loss ratio monitoring, salvage and recovery tracking, and identifying trends to inform underwriting and portfolio management
• Understanding of regulatory framework governing claims handling (General Insurance Code of Practice, AFSL obligations)

Desirable Experience

• Experience supervising or managing a claims TPA, including performance management, file reviews, and SLA monitoring
• Diploma of Insurance (Claims) or equivalent (e.g., ANZIIF CIP, relevant degree in law, commerce, or business)
• Exposure to other commercial risk classes such as Public Liability, Professional Indemnity, and Property.
• Exposure to fleet risk management and loss prevention
• Experience in client-facing claims advocacy or disputes as well as working with distribution partners
• Experience in supporting claims advocacy for business clients and/or brokers.

Skills & Attributes

• Strong analytical skills with ability to interpret claims data and identify actionable insights
• Excellent attention to detail, particularly in file review and compliance assessment
• Effective communicator with ability to manage stakeholder relationships (TPA, insurers, distribution partners, clients)
• Proactive problem-solver who takes ownership of outcomes
• Ability to work autonomously in a fast-paced, growing business with high attention to detail
• Commercial mindset with focus on both achieving favourable client outcomes and portfolio performance

What We Offer

• Fully remote or hybrid working arrangement (Sydney office available)
• Opportunity to shape the claims function in Australia’s fastest growing insurtech
• Collaborative, supportive team environment
• Competitive salary commensurate with experience

How to Apply

Please submit your CV and a brief cover letter outlining your relevant experience to skye@upcover.com or anish@upcover.com or just linkedin DM either of the founders. We encourage applications from candidates with diverse backgrounds and experiences.