Altus Insurance whitepaper spreads - Flipbook - Page 29
On the branch line –
the TPA perspective
Chapter Summary
• The current model for many insurers involves the delegation of claims management to third party
administrators (TPAs).
• As insurers look to innovate, TPAs may end up in a position where they are competing with the insourcing of claims.
• TPAs will need to keep pace with innovation to ensure they are providing a service which meets their
insurer clients’ visions of claims management.
• Both large-scale and emerging TPAs have started to develop their own technology propositions,
either as part of their core services or as more modular so昀琀ware services alongside outsourced claims
management.
• To become the long-term transformation partners for insurers, TPAs therefore need to be focussing on
innovations in the claims sector, and develop propositions that are flexible and modular to meet the
needs of their insurer clients.
Delivering true transformation would be a lot easier if insurers controlled every
aspect of the claims service. But of course, they don’t. The claims handling
process is fragmented with most insurers using a combination of third party
administrators (TPAs), brokers, loss adjusters and technology vendors to help
facilitate the delivery of their customer promise.
Innovation in the TPA / Loss Adjuster sector.
Some insurers do manage their claims entirely
in-house, but this is the exception rather than the
rule. The vast majority outsource various aspects of
their claims service, be that engaging a third-party
administrator (TPA) or loss adjuster to manage claims
for niche products and add-ons, or outsourcing the
management of claims for entire lines of business.
In recent years, there has been a trend towards brokerfocused insurers encouraging greater engagement
from intermediaries, while the larger loss adjusters
and defendant law 昀椀rms will also act as TPAs for a
range of claim types.
The motivations for outsourcing the most important
service element in insurance range from a desire
for scalability in a growing business and entry into
a new market to the most common motivation for
outsourcing, cost saving. Whatever the motivation,
these partners will play a crucial role in whether or not
an insurer can secure real and lasting transformation
in their business. Third parties managing claims on
behalf of insurers will need to adapt at the same pace
and in the same direction as their multiple clients,
which is no easy task, but there are some clear
examples of innovation in the sector, with some of the
major loss adjuster and TPA 昀椀rms are starting to o昀昀er
their own technology solutions.
Davies, for example, provides a digital portal and
claims tracking tool, remote adjusting services as well
as the use of speech analytics and AI to identify fraud
or potentially vulnerable customers. This is just one
example, but the emerging solutions are inextricably
tied to the claims service and demonstrate a
capability to align with an insurer’s strategic
ambitions.
Looking beyond the major TPAs, there are models
emerging which combine outsourced claims services
with new so昀琀ware propositions, such as Coplus with
its Cobalt solution and Claims Consortium Group and
its Synergy platform delivering process management,
claims tracking and weather data integration as part
of its services.
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