Ways TPA handles the technicalities of Insurance Claims Management System

Ways TPA handles the technicalities of Insurance Claims Management System The increased complexities of managing claims within insurance industry have made many financial companies associate with a reliable Third Party Administrator(TPA). TPA, as an inter mediator, can efficiently handle all types of insurance claims including health, property and causality, life, etc. By reducing bottlenecks and analyzing future risks, TPA streamlines the overall claim process.

This, in turn, helps insurers to bring innovative products and services in line.

By incorporating advanced online claims administration system, TPA offers numerous benefits including technical competency, 24/7 access to claims information/documents, detection of fraudulent claims, handling of loss fund on client’s behalf and false claims, delayed settlements, etc.

Let’s check in detail how TPA streamlines claims management system: Specialized Consultation For Customers: Right from a direct notification to an XML notification from the policyholder or a broker, insurers can receive new claims report through various sources. Here the role of the TPA comes into play who is responsible for processing these claim speedily. The process of keeping these claims in order begins with implementing Data Protection Act (DPA) checks and inspecting details to identify the extent of the loss. This way, TPA handler becomes able to understand the overall policy cover and loss details of the clients. After getting all the details at fingertips, TPA gets in immediate touch with the clients and educate them on the best possible solutions, claim processing and proactive prevention.

Leverage latest technology for handling claims and capturing data efficiently: For any insurance company, upgrading a system’s flexibility and functionality is not an option but a necessity. In case of continual use of legacy systems, chances are, a TPA handler won’t be able to capture data in real-time, which can impact customers interaction immensely. To avoid this, TPA utilizes best technologies to interact with clients and customers via applications and facilitate data transfers.

Getting a digital edge provides real-time analytics and reporting, through with insurers can track status, financials, and adjuster performance.

Maintains necessary bordereaux and management information (MI): Preparing bordereaux could be challenging since it involves a comprehensive system interrogation and reporting. And thus, TPAs utilizes flexible reporting tool

that can withstand multiple data fields. Additionally, TPA Performance MI Suite ensures that company maintains fund levels right after issuing the bordereau.

Systematic and comprehensive audits: Companies should frequently perform audits on TPA may be through their portal or any audit functionality. But here, the access should be strictly restricted to the auditor only so as to maintain data integrity. On the other side, TPAs also have their own audit procedures for checking data and all related aspects along with the added mechanism for feedback and staff training.

Staff-training on technical knowledge: TPA handlers are required to stay updated on some of the key subjects including DPA, financial crime, sanctions, etc. And for this reason, TPAs should conduct an annual training session to train their staff, maybe through e-learning training tool.

Also, with the usual technical training portfolio, TPAs can ensure that their staff has the required technical knowledge and communication skills, which is prerequisite while interacting with customers. Also, identifying customers complaints falls into this space. Thus, TPA employs robust procedures such as issuing of a Summary Resolution Communication (SRC) and detailed returns to the underwriter, to resolve them.