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Claims TPA Monitor

The TPA Report analyses strengths and weaknesses of different TPA’s and the benefits and drawbacks of using TPA's within an insurer.

Providers broadly fall into two categories: specialist claims management providers and law firms with volume claims services. The latter range from the $1bn+ revenue global providers to smaller bespoke firms in the £10 million range. 

There is a general lack of clarity around offerings, with many firms not clearly communicating the specifics of their operations on the websites. The diverse market extends to services offered and approaches to claims management. 

Some focus on bespoke services tailored to each client, some on technology portals, others reporting or offering cost mitigation services alongside the claims management. Benefits and drawbacks: The benefits to TPAs are seen as: efficiency/cost, bringing in new specialist or local expertise, and dealing with high volume claims particularly where the volume is variable. 

The drawbacks primarily relate to losing direct control of the claims : oversight can be time-consuming, service levels may vary and KPIs need careful setting to avoid potential regulatory issues.

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