Comparing TPAs - 6 Things to Look for in a Claims Service Provider

As business risks continue to evolve, having access to specialized claim services from an experienced third-party administrator (TPA) could give you a competitive edge by protecting your bottom line, especially if the TPA provides strategic, data-driven recommendations to help you get the best possible outcomes on every claim.

Working with the right TPA provider can protect your bottom line by helping to lower loss costs on casualty and property claims leveraging data-driven insights. Guidance from experienced TPAs – backed by deep data and analytics capabilities – can help you take steps to reduce your total cost of loss in the future.

You'll want to choose a TPA that can complement how you do business. For example, does your TPA have sophisticated investigative services and capabilities, expert medical resources, subrogation expertise and superior risk control competency? The right TPA can provide the right subject matter expertise when you need it.

A dedicated Claim team that understands your business and is there when you need them is also important. Constitution State Services has invested in training its Claim professionals at Claim University, a state-of-the-art training facility in Windsor, Conn. Working with highly experienced Claim professionals provide consistency that you can count on. Here are five things to look for when evaluating which TPA may be the best fit for your business.

1. A focus on managing turnover

Before your TPA can care for your employees, they need to care for their own. Look for low turnover rates and reasonable case load assignments. Also, are career path opportunities and mentoring programs in place? These types of programs can help manage turnover.

At CSS, we take a multi-pronged approach to supporting our people through training opportunities, in-house claim resources, diverse benefit offerings and an engaging culture that supports a stable work force. CSS is well positioned to handle claims across all severity levels, jurisdictions and unique causes of loss.

2. Robust data-driven models

Not all TPAs have invested in both the talent and the data it takes to build robust advanced analytical models. A third-party administrator that can optimize claim outcomes by applying the right data and advanced analytics at the right time can be a true asset to your business. For example, Constitution State Services (CSS) uses analytical models that can help Claim professionals identify patterns so that they can develop strategies to successfully resolve claims.

Constitution State Services has integrated machine-learning models across the claim lifecycle so that Claim professionals can use the data to improve outcomes. For example, automated social listening platforms help identify information that can either corroborate the facts of a claim or identify potentially conflicting information.

3. Advanced analytical tools

When searching for an effective TPA, it's important to choose one that gives you the ability to leverage powerful reporting tools. Look for a TPA who allows you the option to monitor the status of claims, evaluate trends, and measure the performance of your third-party partner. Constitution State Services offers a user-friendly digital interface that displays detailed and summary views of claims in progress and the associated costs, down to the activity level.

For real-time reporting views at a glance, CSS offers e-CARMA^®, a risk management information services dashboard that can be customized to each user's style and specifications. Along with innovative reporting functionality that exposes loss drivers, e-CARMA sends alerts when pertinent new claims data is available. The platform's Risk Analyzer provides an interactive way to reduce risk and assess the quality of preemptive programs already in play.

4. A results-based approach

Look for a TPA that helps protect you from potential errors and fraud. For example, it's difficult to thoroughly review large quantities of medical billing data associated with workers compensation claims. Taking into consideration complicated billing platforms, expanded medical procedure codes, negotiated provider discounts and other complexities, there are plenty of opportunities for medical billing errors. These mistakes could trigger overcharges, for things like inpatient stays and outpatient services, which could lead to significant costs to your enterprise.

For workers compensation claims, a TPA with expertise in detecting and resolving medical billing errors can help you be more confident that you are paying what you owe for medical costs and not more. Constitution State Services has a Specialized Medical Audit Review Team (SMART) that reviews workers compensation bills identified for further scrutiny.

5. High-quality investigative services

Errors – human or otherwise – aren't the only driver of excess claim costs. Intentional acts can also play a role. Insurance fraud, no matter where it comes from, can present another hurdle for businesses. If you lack the time and resources to pore through all facets of each submitted claim, your team might benefit from an alliance with skilled investigators from an industry-leading TPA.

Constitution State Services utilizes a 300-plus person investigative services organization, with fire, forensics, medical fraud, cargo theft and other areas of expertise. The team understands local environments and responds in partnership with law enforcement and the National Insurance Crime Bureau (NICB). CSS uses dedicated field investigators to investigate incidents of potential property, liability, workers compensation and auto fraud.

6. Flexibility

It's important to choose a TPA provider that allows you the flexibility to select individual claim management services and capabilities on an a la carte basis, so you only pay for what you need. This approach can complement gaps in your in-house risk management team.

Constitution State Services allows companies to choose claims and administrative services supporting workers compensation, automotive, general liability and property insurance programs, with the flexibility to add additional services as needed.

Rather than a one-size-fits-all solution, look for a TPA that offers you the flexibility to choose the capabilities that best complement your organization. Constitution State Services offers customers dedicated Claim professionals who take an outcome-based approach to claim management, Risk Management Information Services (RMIS), and risk control services.

Constitution State Services also offers transparent pricing, so customers only pay for what they use. For example, customers only pay for subrogation services when they need them, instead of paying for subrogation services as part of a base charge. This flexible approach helps maintain cost-efficiency throughout the claim process.

Getting started with a TPA

For businesses who have multiple locations falling under the jurisdiction of varying and complex state insurance regulations, managing claims can be complex. Choosing the right third-party administrator can help your business navigate the twists and turns of the risk management and regulatory road map.

When evaluating a TPA, it's important to consider the unique needs of your business. Contact CSS to learn more about how we can help manage your claims and keep your loss costs in line.