TPA (Third-Party Administrator)
A company that handles claims processing and administration on behalf of insurers or self-insured employers, without bearing the insurance risk itself.
industryPublished 2026/06/05
FAQs
- What does a TPA do?
- Handles claims processing and administration for insurers or self-insured employers without bearing the insurance risk itself.
- Who uses TPAs?
- Self-insured employers running their own claims programs, and carriers outsourcing certain books or claims functions.
Related Terms
Claims Triage
The automated sorting of incoming claims by complexity, severity, or risk — routing simple claims to fast-track or straight-through processing and complex on.
Fraud Detection
The use of AI and data analytics to identify suspicious or fraudulent insurance claims and applications, flagging anomalies for investigation before payout.
Cycle Time
The total elapsed time to complete a process — most often a claim from first notice to closure.