Third-Party Administrators

One platform, configured for every client program.

TPAs administering claims across multiple carrier relationships configure separate check rules per client program — without rebuilding the intake verification process for each new relationship.

TPA claims specialist reviewing documents at workstation

The TPA intake problem

TPAs administer claims across multiple carrier contracts simultaneously. Each client defines completeness differently — what Carrier A requires for a bodily injury claim differs from what Carrier B requires for workers' comp. Manual first-pass screening for each program is overhead that grows with every new client relationship, and inconsistency is the most common source of client audit findings.

Per-program rule configuration
Configure separate check libraries per client program. Auto collision for Carrier A has different document requirements than workers' comp for Carrier B — Claimloom runs the right rules for each intake stream.
Unified intake quality reporting across programs
Monthly check accuracy reports consolidate performance across all client programs. Flag frequency by check category, re-request rate by claim type, and intake quality trends — in a single report you can share with clients during quarterly reviews.
Webhook routing per program
Flag summaries route to the right destination for each client — direct to their claims system, to your internal queue, or to an adjuster portal — based on program configuration.
Consistent intake handling across all programs
Every program runs the same underlying check engine with its own rule configuration. Inconsistent intake handling — applying different document standards to the same claim type — is among the most common findings in TPA client audits. Claimloom applies the configured rules uniformly, every time.

In Practice

A TPA managing workers' comp and auto programs across four carrier clients

Clearpath Claims Services — a TPA administering workers' compensation, auto liability, and general liability lines for four carrier clients — was manually pre-screening incoming packets using a shared intake checklist maintained on a shared drive. When clients had differing requirements, the checklist became a lowest-common-denominator approximation that missed carrier-specific gaps.

Claimloom replaced the shared checklist with per-program rule configurations. Each carrier client now has its own document requirements and date-chain logic. Flag summaries route to the adjuster queue appropriate for each program. Monthly accuracy reports show performance by program — giving Clearpath data to share in quarterly client reviews.

Clearpath Claims Services is a synthetic example. Claimloom does not disclose customer identities.

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