Four Best Practices for TPA Success


Best Practice #1: Understand Your Groups, Their Participants, and the Needs of Both

First things first: Relationships matter.

This standard applies to third party administrators just as much as any other organization in any other industry. You wouldn’t work with a new employer group without understanding what’s being offered to participants, and they wouldn’t work with you without understanding your unique benefits.

You have to look deeper and go further — just as they will with you.

When employers or brokers approach you for third party benefits administration, get granular. Grab your stethoscope and listen to the pulse of the organization, as it were.

What health plans are they offering their employees? How have employees utilized those plans historically? How have those plans changed from year to year? What are their long-term plans for employee benefits? How much time is their HR team spending on benefits support for employees?

Once you understand how the group has managed its benefits thus far, clearly define what the future will look like once you start to work together.

What are their wants, needs, and expectations? Compare that information against past data so you can chart a well-defined course for fulfilling those wishes and goals in the most streamlined, efficient way possible.

This shows that you understand your client, care about their goals, and want to maintain a productive relationship with them and their employees. It’s good old-fashioned customer service.

Best Practice #2: Understand the Technology Your Clients and Their Employees Use

There thousands of HR platforms, portals, and tools available on the market for employers and their people to use — to say nothing of custom-built software programs.

While the responsibility of selecting a platform belongs to the employer, the responsibility of working with what they’re using belongs to you.

So, how does your benefits administration platform fit in — if it does at all? Moreover, what’s the format of the data you receive from clients’ platforms, and how will it integrate with your benefits administration system?

Employer HR platforms produce enrollment information differently, so unless you have a solution for streamlining and standardizing that information, you might find yourself manually reviewing and organizing enrollment files. This can quickly become a time-consuming process, especially when employers are renewing plans at the end of the year.

Understanding the tools your clients are using now and how they integrate with your system (again, if at all) is paramount to a healthy and successful TPA–client relationship. Brokers and employers are relying on you to serve as a reliable partner, so ensure you fully understand what your clients are using and how they use it.

Best Practice #3: Understand Tools You’ll Need to Continue to Grow Your Business

We’ve covered the value of relationship building with your clients as well as the importance of understanding your clients’ HR platforms.

The next recommended best practice follows suit: Understanding how you are going to manage claims and enrollment data coming from different systems in different formats.

As a TPA, you might be wondering how your benefits administration platform can help manage claims and enrollment data. How can you take all of the files you are receiving from different carriers, employers, and vendors and streamline the process to import those files into your existing benefit administration system. Many TPAs hire a few employees to help manage all of these files and ensuring they are all imported into your benefit administration system. Even with skilled technical team members, the process is challenging, costly and time consuming.

But there is a better way.

Custom development can be expensive and time-consuming. Tools are available now that allow you to easily integrate with your benefit administration platform and HR and Enrollment solutions your employer groups are already using.

The bottom line is that, as a TPA, you need to do what makes sense for both your customer, their employees, and yourself. This means taking advantage of time-saving solutions that make life easier for everyone.

Best Practice #4: Understanding Your Plan Design

As a TPA, you manage whatever benefit plans are sold by brokers to employer groups. This includes flexible spending accounts (FSA), health savings accounts (HSA), and health reimbursement accounts (HRA).

But how are you managing plans as a whole? At a higher level?

In addition to helping your client companies provide health benefits to their employees, another significant aspect of your role as a TPA is helping employers mitigate risk. Whether your client companies are utilizing fully insured or self-insured plans, you’re there to ensure that the services they’re entrusting to you are managed in a timely, responsible manner.

The systems you use should help you to manage these functions as efficiently as possible — for the benefit of plan participants, employers, brokers, and your organization. Ultimately, working with tools that allows you to do so will reduce the time spent performing certain tasks that should be automated or streamlined.

Consider a Solution that Helps You Work Smarter and Faster

We’ve covered four best practices for TPA success:

  1. The importance of building strong relationships
  2. Understanding the technology your employers are using
  3. Understanding how your benefits administration system fits in
  4. Understanding how you’ll be managing what employers offer

If you haven’t already done so, it’s time to start considering how your current benefits administration platform could be improved or enhanced. That doesn’t mean you have to invest in a new platform or spend time and money developing something entirely new. You simply need to look for a way to bridge the gaps.

Why not use a platform that makes it easy to add a new employer group to your existing benefits administration software?

Why not use a platform that seamlessly pulls data from employers’ existing HR platforms and integrates with major benefits administration tools like Alegeus, DataPath, and Wex Health?

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Why TPA Stream

TPA Stream is a thriving, innovative insurance technology company committed to empowering better benefits by connecting systems, transforming data, and helping TPAs unlock more revenue.

Learn more about TPA Stream here.

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