TPA Claims Software

Claims administration at the centre

Purpose-built for third-party administrators - a configurable claims workbench, reserves, payments and recoveries, with the reporting your clients expect.

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Claims your way

Configure the desk to each client's process.

Controls & SLAs

Payment controls and service targets built in.

Many clients, one platform

Run multiple programs side by side.

Run claims for every client, your way

Handle multiple programs and clients on one platform, each configured to its own rules and workflows.

Capabilities

Customizable platform suited to TPA needs

Run each client's process, not one compromise

Every client gets a claims desk shaped to their own rules, authority limits and correspondence, on a single platform your team already knows. You stop telling prospects that your system cannot do it their way.

Prove your service levels with data

Turnaround, cycle time and outstanding work are tracked as you handle claims, so client reporting comes out of the system rather than a month-end spreadsheet. SLA conversations start from evidence.

Take on a new program without a new system

Adding a client or a line of business is configuration, so a win does not trigger an implementation project. You can bid for work knowing what onboarding actually costs you.

What's included

Everything you need in one TPA platform

Configurable claims workbench

Shape the desk to each client's process: their claim types, statuses, routing and screen layout. Adjusters handling several programs work the same way in each, without a different system per client.

Reserves & payments

Set and revise reserves, then approve payments within authority limits agreed with each insurer. Approval thresholds and movement history keep you inside the mandate you were given.

Recoveries

Subrogation and salvage tracked against the claim, so recovery income reconciles back to the file and your client sees a true net cost.

Client reporting

Each insurer gets the numbers they asked for, on their own cadence, generated from live claims data rather than assembled by hand at month end.

Service targets

Track turnaround against each client's SLAs, with overdue work surfaced in the queue before it becomes a service credit conversation.

Any line of business

Property, motor, liability, medical or specialty programs run side by side on one platform.

How it works

Up and running, fast

Intake

Capture claims across programs.

Adjudicate

Verify, reserve and review.

Settle & report

Pay, recover and report to clients.

See it in action

Administer claims for two clients at once

A TPA runs claims for two insurers, each with its own rules and reporting.

Configure per client

Each client's claim types, workflow and limits are set up separately.

Adjudicate

Adjusters work each program on a tailored workbench.

Report

Each client gets its own reporting, with a full audit trail.

Illustrative example built on Openkoda's demo products.

Who it's for

TPA Claims Software Built for Your Team

Built for third-party administrators and claims management companies running programs for several clients at once. Each client gets a claims desk shaped to their own rules and reporting, while your team works in one platform and can prove service levels from live data.

FAQ

Questions, answered

Can we run different processes per client?
Yes. Claim types, workflow, limits and reporting are configured per program, so each insurer gets the handling model they signed up for. Onboarding a new client means configuring their program alongside the others rather than standing up another system.
Are payments controlled?
Yes - reserves, approval limits and a full audit trail on every payment. Authority is enforced by the platform rather than by memory, so an adjuster cannot quietly settle above the limit the insurer set for that program.
Can we report per client?
Yes, with client-specific reports and dashboards drawn from live claims data. Because reporting is generated rather than compiled by hand, month-end packs stop competing with the day job.
Can we track SLAs?
Yes. Service targets track turnaround against each client's SLAs, and work approaching or breaching a target is surfaced in the queue while there is still time to act on it.
Can we keep each client's data separate?
Yes. It's multi-tenant with strict data isolation enforced at the data layer, so each client's claims, users and reporting stay separate. That separation is usually the first thing an insurer's audit team asks a TPA to evidence.
How quickly can we onboard a new client program?
Claim types, workflow, limits, documents and reporting are configuration rather than a development project, so a new program is typically set up in days or weeks. You can model it alongside live programs and switch it on when the client signs off.
Can our clients see their own claims?
Yes. Role-based access and the client portal let each insurer see their own programs and claims, without exposing any other client's book. It replaces the usual cycle of emailed status spreadsheets.
Do we own the data if we change platform or lose a client?
Yes. Your configuration and data are yours, on Managed Cloud or On-Premise. Client data can be exported cleanly when a program ends, which is often a contractual requirement in TPA agreements.
Related

Explore more of the platform

Claims Processing

Settle claims faster, from first notice to payout.

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Workflow Engine

Design your process visually, drag-and-drop.

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Reporting & Dashboards

Answers in plain English; dashboards per role.

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See Openkoda in your context

Book a live, personalized demo with our product team - tell us your use case and see the platform work with your data. No commitment.

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