Replacing Legacy Systems With Future-Proof Technology For A Leading TPA

The Challenge

Operating as a multi-country TPA introduces significant complexity across policy management, claims processing, provider networks, and regulatory compliance.

Key challenges included:

• Managing policy administration and pricing at scale
• Handling provider relationships, contracts, and reimbursements
• Automating claims approvals and adjudication processes
• Integrating financial transactions with accounting systems
• Ensuring compliance with varying regulatory requirements
• Improving visibility into member utilization and service delivery

The client needed a unified system that could replace legacy infrastructure while supporting future growth.

What We Did

We designed and implemented a comprehensive insurance technology platform covering core operations, digital access, and operational support:

Core System

Delivered a new core insurance system to manage critical business functions, including:

• Policy and pricing administration
  Managing customer relationships, policy pricing, agent handling, and policy renewals.
• Provider management
  Handling provider profiles, financial details, contracts, and network management.
• Approvals and claims adjudication
  Automating approvals and claims processing through advanced rules engines.
• Financial processing and reimbursements
  Managing transactions related to claims and reimbursements, with seamless integration into financial systems.
• Regulatory compliance
  Ensuring compliance with regulatory requirements across multiple jurisdictions.
• Customer service enablement
  Supporting customer service operations through health records management and integration with communication systems.

Portals

Built dedicated portals to improve engagement and streamline operations:

• Provider portal
  Enabling efficient profile and contract management, batch claim submissions, and comprehensive reporting.
• Partner portal
  Supporting management of portfolios, requests, billing, and performance metrics for brokers, agents, and employers.
• Member portal
  Providing access to policy details, claims submission and tracking, provider networks, and reporting capabilities.

IT Operations Support

In addition to platform delivery, we acted as a trusted technology partner by:

• Supporting best practices across the client’s IT operations
• Providing ongoing IT support services
• Advising on system improvements and changes

The Impact

The new platform delivered measurable operational improvements across the organization:

• 2× increase in active covered lives within five years
• Reduced time required for member utilization tracking
• Up to 40% reduction in operational costs in specific areas

These outcomes enabled the TPA to operate more efficiently while supporting growth across markets.