For TPAs, Customer Convenience Can Make or Break a New Relationship

tpa customer convenience

The Last Thing You Need is a Confused Customer

When your broker brings you in on a new opportunity with an employer or employer group, a lot of promises and assurances are made. Employers want to be certain that everything is going to go smoothly — both for them and their employees. They want to know that not only will the broker connect them with an insurance solution that meets employees’ goals as well as their organizational goals, but they also want to have peace of mind in knowing that once they sign, the many pieces and parts involved are going to be managed.

As employee claims start coming in, if you can’t handle the influx, or if you’re requiring too much from the employees and they’re confused, the complaint-chain is going to start forming. First, the plan participants will voice their concerns to the employer’s HR department or even the insurance carrier potentially. From there, the employer will either contact you or the broker to voice their concerns. Whether they contact you or the broker, the broker’s trust in you as their TPA of choice is going to hang in the balance.

You’ll have to work even harder to dig yourself out of this situation. And because so many TPAs are still operating with manual processes like emails and even faxes for claims substantiation, that’s going to be tricky to accomplish.

Also, don’t forget that EOBs can be confusing for plan participants. They’re often delivered looking just like a bill, even though the document typically states “this is not a bill.” When received, it’s understandable that a participant might not know what it is or even what to do with it. When you reach out to them to assist with substantiating their claim, they may have no idea what you’re asking for (and hopefully they still have the document!). 

Use Integration and Automation to Take This Off the Participant’s Plate

If your TPA isn’t already using an integration between your benefits administration system and the employer’s insurance carrier, now is the time to make that change to make improvements to TPA customer convenience. As the healthcare industry continues to grow and shift, the value of a solution for an automated customer experience can’t be overstated. As a TPA, customer convenience must be a focus, and utilizing a solution such as this will be incredibly useful as your workload continues to increase.

Using the integration between your benefits administration platform and the carrier, plan participants will no longer need to manually handle their EOBs, experience confusion when you contact them to request it or have to deal with inaccuracies and the resulting errors from a file that was incorrectly substantiated due to a heavy workload. They simply provide their credentials to their insurance carrier for you, and your platform takes care of the rest.

The benefits are both immediate and long-term. For now, the plan participant or their family member experiences no friction in the process. Everything is handled automatically for them. Long-term, and multiplied by the number of participants being served, employers experience fewer concerns or questions and greater participant/employee satisfaction. Brokers, an important revenue source for TPAs, hear only positive things from their employer clients.

TPA Customer Convenience Also Factors into Sales

While an automated solution certainly helps to strengthen relationships, it also helps employers and brokers know what to pursue or eliminate with each plan year. Your role in managing participant claims provides a wealth of data that goes to inform these decisions, which in turn impacts the healthcare plans and products that are sold. This, in turn, impacts your bottom line in terms of additional claims to manage and services to offer.

Going even further, streamlining TPA customer convenience across the board makes you a valuable part of your broker or brokers’ sales strategy. They become a channel partner for you because they know your value and what you can bring to the table. They know that they can approach a prospective employer or employer group, and that you’re going to deliver the TPA customer convenience that produces positive results in every customer touchpoint.

Enhance Your TPA Customer Convenience for Long-Term Results

TPA Stream has built a best-in-class integration solution for TPAs looking to not only make their internal operations more efficient and productive but also to strengthen relationships and increase profitability for the long term. Our platform integrates with popular benefits administration platforms and offers numerous carrier connections, ensuring that you’re able to deliver the TPA customer convenience that participants need and employers expect.

Learn more about our platform in a private demo.

Posted on Blog

Ready to Make Your Health Data Integration Easier?