Third party administrators (TP As) have always recognized the value of data and the
importance in effective data management. Today, in the era of Big Data, TPAs are becoming
even more skilled at using data to gain greater customer insights and deliver greater value. As the
trusted stewards of their customers’ claims administration, TP As are in possession of massive
amounts of data. By organizing and analyzing this data, they can support their customers’ better
decision making on matters ranging from insurance product offerings and cost factors to
utilization management. Self-funded plans, in particular, benefit from the TPA’s proactive role in
data management and intelligence garnered from this data.
Rich Data, Robust Reports
Health insurance claims are at the center of the TPA’s data management. These claims
contain a wealth of data (i.e., medical, demographic, financial, etc.) which can be integrated and
analyzed to guide plan sponsors’ strategic decision-making leading to new plan strategies, better
risk management and lower costs. Robust reports to customers and their brokers provide a bird’s
eye view of plan activity, trends and new opportunities. The TPA’s emphasis on quality control
and performance monitoring is also enhanced by its better leveraging of data to measure key
performance indicators such as how efficiently claims are being handled. Additionally, data
analytics serve as a valuable tool in providing meaningful insights regarding potential risks
including legal claims.
Helping Insurance Carriers
Insurance carriers too derive benefit stemming from the TP A’s harnessing of data. The
TP A’s data management assists in the area of cyber security and the heightened regulations
imposed on carriers to protect sensitive data from cyber breaches and identity theft. The
actionable data insights shared by TP As also enable carriers to strengthen their strategic business planning and compete more effectively. Predictive analytics can lead to decisions relating to new products, services and/or risk mitigation strategies. As a result, carriers look to TPAs as important partners in key operational areas including underwriting and customer relationship management.
Leveraging Big Data, TP As are on the frontline in helping all stakeholders (i.e., plan
sponsors and carriers) gain a heightened level of value defined as better risk and cost
management, heightened awareness and enhanced customer relations.
