Tag: TPA

TPA Technology Guide Series #2: The overlooked advantage of improving customer communication through the digital experience

A recent Business Intelligence article draws from a Redhand report claiming that “of all of the subsectors of the RMIS industry, the third-party administrator sector is the one that is the most in transition.” The article suggests this may be due to the fact that TPAs are trying to remain competitive while relying on fewer resources than insurers.

What is clear, according to the Redhand report, is that TPAs are trying to level the playing field with technology. “As will become obvious, there has been a lot of investment and improvement in the TPA sector regarding information technology…” The larger question is, are these substantial investments in upgrading systems even focused on the right area? A survey of customer data indicates this may not be the case.

read on

TPA Best Practices #3: Selecting Technology Partners

The Importance of Technology Partners

Choosing a technology partner is increasingly becoming a more critical strategic decision for TPAs. In Accenture’s Technology Vision for Insurance 2017, 76% of respondents agree that “competitive advantage will not be determined by their organization alone, but by the strength of the partners and ecosystems they choose.” Identifying technology solutions that support the company mission and differentiate your organization from the competition is an important part of developing an effective business strategy.

read on

TPA Best Practices #2: Success with Evidence Based Medicine and Comorbidities

A major 2016 Workers’ Compensation benchmark study found that one of the largest differentiators of high-performers versus all other groups was the use of Evidence Based Medicine (EBM) guidelines. Users of EBM data were more than 4X more likely to be top performers than those who did not. The same study included a survey asking “What are the greatest obstacles to achieving desired claim outcomes?” Respondents ranked “Psychosocial/comorbidities” as the number one issue.

read on

TPA Best Practices #1: The Power of Automation

A 2016 workers’ compensation benchmark study found that half of all high performers employed automation at specific intervals in the claim cycle. Additionally, high performers were almost 4X more likely to rely on automation throughout the cycle than all other groups. Given that another workload study, which conducted over 4,500 interviews with claims professionals, found that adjusters spend up to half of their hours on non-core tasks, it is clear that removing administrative burdens on adjusters is critical to becoming a high performer in the industry.

Employing Workforce Automation with Origami Risk

The workload study estimates that the average adjuster has 130 open cases, with an average of 20 attachments per case, many of which are sent via email. If it takes an adjuster 1 minute to open the email, download the attachment, and then upload it into the case file, it would take one full week simply to manage those documents. With Origami Risk, this process takes seconds. When a case-related email with attachments is forwarded to a dedicated Origami address, the system verifies access rights to the proper claim based on the sender’s mail address. It then uploads the email message, along with all attachments, directly to the claim record.

read on