The Critical Role of Claims for Third-Party Administrators (TPAs)

Third-Party Administrators (TPAs) are responsible for processing and administering claims in a timely, efficient, and accurate manner, but traditional methods can be complex, time-consuming, and prone to errors. For instance, it can take weeks or even months to resolve a claim, which can be frustrating for clients and costly for TPAs. Moreover, manual intervention can lead to errors, delays, and inefficiencies, hindering TPAs’ ability to provide high-quality service and meet the evolving needs of clients.

Therefore, TPAs need a modern and streamlined claims management system that automates processes, reduces costs, and enables efficient and accurate claims resolution to ensure the financial stability and success of TPAs and their clients.

Key Challenges of TPAs’ Claims Management

Onboarding New Clients

TPAs need to onboard clients efficiently and start delivering value as quickly as possible. Traditional onboarding processes can be time-consuming and resource-intensive, often requiring manual processes and extensive communication with clients.

Efficient and Accurate Claims Processing

Due to the complex nature of claims, claims management processes can be labor-intensive, error-prone, and time-consuming, leading to delays, increased costs, and reduced customer satisfaction. Additionally, claims management requires a high degree of accuracy, as errors or inconsistencies can result in legal disputes, reputational damage, and financial losses.

Effective Communication

TPAs need to communicate with clients across multiple channels, such as email, phone, and messaging, while keeping track of all communication and client interactions. Managing communication across these different channels can be time-consuming and challenging, and it can be difficult to ensure that all communication is captured and tracked in a way that is easily accessible and actionable. Failure to effectively communicate with clients can lead to dissatisfaction, delays, and increased costs, all of which can negatively impact the TPA’s reputation and business outcomes.

Customized Claims Management Workflows

Traditional claims management solutions often require extensive customization and coding to create workflows that meet the unique needs of each carrier, which can be time-consuming and resource-intensive.

Training New Adjusters

Adjuster onboarding processes in TPAs’ claims departments can be time-consuming and resource-intensive, often requiring extensive training and technical knowledge. This can lead to delays in delivering value to clients, reduced productivity, and increased costs for TPAs.

Tracking Clients’ Operations

Conventional methods like spreadsheets can be labor-intensive, prone to errors, and cannot provide real-time insights.

Benefits of Five Sigma’s CMS for TPAs

Our cloud-native data-driven claims management solution makes your claims processing simple and smart.

Quick Time to Value

Our advanced claims system enables you to onboard clients in just a few minutes! This allows you to start delivering value to clients more quickly and efficiently. By streamlining the onboarding process, our claims management solution enables you to dedicate more time to servicing clients and addressing their specific needs, resulting in greater customer satisfaction and improved business outcomes.

Self-configuration No-code Rule Engine

Our powerful self-configuration no-code rule engine empowers you to configure unique workflows for each carrier, without any development resources. This includes advanced configurations such as:

  • Selecting multiple lines of business
  • Configuring exposures and coverages for specific lines of business
  • Defining assignment rules and workflows
  • Creating notifications
  • Adding payment method
  • Setting up telephony configurations… and more!

Integrated Omnichannel Communications

Unlike other systems that require separate platforms for each communication channel, our CMS features an omnichannel communication module that encompasses every channel (SMS, mail, voice video calls) within a single platform. Moreover, it automatically logs all communication, including notes, files, and messages received from clients, which facilitates more effective communication and simplifies assistance when adjusters are out of office.

Intelligent Automation Across the Claims Lifecycle

Our advanced intelligent automation capabilities automate tasks across the entire claims lifecycle such as populating policy data, assigning claims, verifying coverage, setting reserves, scheduling inspections, tracking subrogation, and setting payment rules. This reduces the time and resources required for claims processing, allowing you to allocate their resources more effectively and efficiently, and reduces the cost per claim.

Fast & Intuitive Onboarding for Adjusters

New adjusters can be trained and onboarded in just 15 minutes, thanks to our user-friendly interface and intuitive design. With our claims management solution, you can rapidly onboard new team members and get them up to speed on the platform’s features and functionality without extensive training or technical knowledge.

Dashboards and Reporting

Our embedded dashboards and reporting can be filtered per client, allowing you to track and monitor your clients’ operations and provide actionable insights that will help them make strategic management decisions. So much better than using spreadsheets!

Customer Story: Xceedance Improves Insurance Claims Ecosystem with Five Sigma

Hear why Xceedance chose Five Sigma’s claims management solution to build their TPA claims operation and improve their insurance ecosystem. Here are some highlights: