How Carriers and TPAs Collaborate to Drive Better Claim Outcomes

The partnership between a carrier and a third-party administrator (TPA) is not just operational, but strategic, as it directly impacts outcomes for insureds. While roles may differ, both parties share the same goal: delivering effective claims resolutions that benefit insureds.

“TPAs are on the front lines of claims management, while carriers are providing essential expertise, resources, and stability to keep the claim moving forward,” said Steve Prewitt, Large Casualty Workers’ Compensation Claims Manager at Safety National. “This collaboration can provide a more resilient claims process for insureds that also adapts to workforce turnover and industry change.”

The Evolving Landscape of Claims

Adjuster turnover has become an industry-wide challenge, leading to variability in adjuster experience and consistency. This turnover can create gaps in knowledge and delays in the process, but carriers can help bridge those gaps as educators. When an adjuster is new or assigned a different claim, carriers can help familiarize them quickly, ensuring claims do not stall due to staffing challenges.

Carriers have also expanded their role as educators, conducting more frequent conference calls with claim stakeholders and engaging directly with TPAs, brokers, and insureds. During adjuster transitions, carriers can act as a steadying presence to maintain continuity. The time they invest can help ensure claims are handled with expertise despite turnover.

Balancing Technology and Human Touch

TPAs are rapidly adopting automation and AI tools to ease heavy workloads, as they present opportunities to free adjusters from repetitive, manual tasks. These tools are adopted to streamline routine tasks like generating summaries and flagging deadlines. However, these tools require caution, since this technology can often misrepresent case details, which can be dangerous in a people-centered industry.

Carriers often advocate for integrating this technology simply as an additional tool, and not as a replacement for the human aspect. Automation should free adjusters and carriers to focus on strategy and communication in their claims handling while including the human touch. For insureds, this balance delivers the best of both worlds: the speed and efficiency of technology alongside the assurance that claims decisions are still made with context and expertise.

What This Means for Insureds

For insureds, the carrier-TPA partnership translates into stability and continuity. Even with high adjuster turnover, carriers step in to educate new team members and keep claims moving forward, preventing costly delays and ensuring no details fall through the cracks.

Insureds also benefit from the combined expertise of both partners. TPAs bring frontline knowledge while carriers add strategic oversight. Together, they deliver faster resolutions, clearer communication, and a balanced approach that leverages technology without losing the human touch. The result is a claims process that adapts to industry change while keeping insureds’ interests at the center.

The Road Ahead

While the industry continues to focus on predictive analytics and AI, the need to keep the human element in sight remains ever more critical. The carrier-TPA partnership may help safeguard against future instability, ensuring that claims resolutions remain reliable, despite rapid changes in the industry. Together, they balance innovation with expertise, delivering claims outcomes that remain reliable, efficient, and human-centered as the industry evolves.