What Should Employers Look for in a TPA Claims Report? Key Metrics Explained
A useful TPA claims report helps employers understand health plan spending, enrollment-adjusted trends, major cost drivers, claim status, and administrative performance. Before comparing results, confirm the reporting period, metric definitions, and data completeness. The report should explain unusual changes and identify follow-up actions while protecting members’ health information. For CFOs, HR leaders, benefits teams, and […]
What Is Subrogation and Why Does It Matter in Claims Administration?
What is subrogation? Subrogation is the process of seeking recovery from a third party that may be responsible for a loss after a claim has been paid. In simple terms, one party pays a claim and may then seek reimbursement from the party responsible for causing the loss. In claims administration, this creates an important […]
What Happens After a Workers’ Compensation Claim Is Reported?
Reporting a workplace injury starts the claims process, but it does not end the employer’s involvement. If you are asking what happens after a workers compensation claim is reported, the claim is typically reviewed, assigned, investigated, and monitored. The administrator may coordinate with the employer, injured worker, medical providers, and other parties while tracking documentation, […]
When Should an Employer Consider Switching Third-Party Administrators?
Changing a third-party administrator is a significant operational decision for an employer with a self-funded health plan. A delayed response, difficult claim, or isolated administrative error does not automatically mean the relationship should end. However, recurring problems with communication, reporting, claims administration, vendor coordination, member support, or plan strategy may indicate that the current arrangement […]
Independent TPA vs Carrier-Owned TPA: What Brokers and Employers Should Know
Two TPAs may offer claims processing, eligibility administration, reporting, and member support while operating under very different ownership structures. Understanding the independent TPA vs carrier-owned TPA distinction can help brokers and employers evaluate how an administrator may affect vendor choice, plan design, technology, and service. Neither structure is automatically right for every employer. An independent […]