Reinsurance
Product Family

By

Conducting business globally means coordinating plenty of operational elements so that everything works smoothly, no matter where your operations are. It also means when things go awry and claims are made, they too are spread out on a global scale.

What’s more, those claims will be handled differently depending on the jurisdiction. And most insurers, no matter how large, can’t efficiently administer all claim programs with internal staff on a global scale.

Having Third Party Administrator (TPA) partners that can deliver comprehensive, smooth claims handling can give insurers a huge advantage in serving their customers. The right TPAs, and the right relationship with the TPAs, can free internal resources, improve the overall operational efficiency for insurers, and improve customer outcomes.

AXA XL uses a robust TPA selection and management process to ensure efficiency, information security, compliance, and technical excellence for claim functions delegated to TPAs. AXA XL works closely with the world’s leading TPAs and our partnerships consistently deliver excellent results.

Advantages
Particularly outside of the US, we use TPA solutions to provide claims handling for clients with more frequent claims and low or no deductibles, at lower cost. Our partner TPAs can handle claims from the ground up. They have the sophisticated technology to quickly and efficiently settle claims. AXA XL’s Claim Account Managers direct the whole claims program and support the client.

Our partner TPAs also allow us to segment our claims. Suppose a client wants to maintain closer scrutiny on claims involving reputation risk. We can have those claims managed internally, while allowing the TPA to handle more routine claims.

Likewise, in the US, we require our TPA partners to demonstrate extensive jurisdictional and regulatory knowledge. Our TPA partnerships create jurisdictional scale that we otherwise might not have. Our TPAs deliver the technical capability that allows us to confidently write business in any state, providing the adjusters on the ground, the risk management solutions that are needed in that jurisdiction, and the claims handling expertise to allow your business to operate smoothly.

Our TPAs can add data and enhance systems quickly and cost effectively, allowing for easier regulatory compliance. For example, California recently put in a specific set of employer requirements around COVID-19 amid the pandemic. Our TPAs were able to rapidly build online portals and other tools to help our insureds comply with that law.

Selecting the right TPAs is a critical first step to delivering better results for clients and for their bottom line.

Choosing TPAs
Selecting the right TPAs is a critical first step to delivering better results for clients and for their bottom line. The TPAs become the front lines of the claim operation. They act as an extension of the insurer, the face of the company that many clients see and interact with. AXA XL has an extensive due diligence and onboarding process.

The best TPAs:

  • Communicate effectively and often
  • Partner with the insurer’s internal team to ensure consistent service and messaging
  • Offer all the tools necessary to process claims smoothly
  • Respond quickly to events and changing needs in the market

In Continental Europe, where the use of TPA solutions is not even a decade old, our TPAs work with claims staff in each country. These staff take on the role of Claim Account Manager. As TPAs work directly with brokers and clients, it’s important that the claims account manager has a close relationship with the TPA so that if there is an issue, they can work together to provide solutions.

Our TPAs are selected based on analysis of their capabilities, their expertise and their skill levels, which lines of business they are experienced in, the financial strength of the company, and their IT systems and security levels. Also, TPAs that have existing relationships with insurers often have an advantage.

Evaluating & monitoring
In the US, where we have both unbundled and outsourced TPA relationships, we rely on good claim contracts, effective auditing processes, the claim account management process, and scorecards for TPA performance. In unbundled accounts, the insured’s risk management team selects and compensates one of our partner TPAs; in an outsourced TPA arrangement, AXA XL chooses and pays the TPA. Our contract, audit, account management, and scorecard processes apply to both unbundled and outsourced TPA arrangements.

The contract
Our TPA contracts, developed over many years of interaction with leading TPAs, specify what services the TPAs will provide, and what AXA XL will handle internally. The agreements set forth a schedule and process for the TPAs to report loss information to us and include who will be responsible for selection and management of others who will be working on claims, such as attorneys, investigators, or managed care vendors.

Since in the US, insurers own the data prepared by the TPAs on their claims, our TPA contracts carefully define how that data will be used, particularly since the TPAs work with other insurers. TPAs sometimes can aggregate and anonymize data across insurers, which allows for deeper insight into what’s happening in the market itself.

The audit process
Our audits of our partner TPAs are essential for understanding what is happening with the claims being serviced by the TPA. The audits score the TPA on technical and operational elements. For example:

  • Did the claim owner actively drive claims handling management, and not abandon it to external vendors? (technical)
  • Was the claim owner properly licensed, where necessary, to adjudicate the claim? (operational)

In Europe, the audit process is similar. A TPA audit plan is prepared by the Claim Delegated Arrangements Team every year and the Claims Account Managers are asked for their feedback. The audit report allows the Claims Account Managers a place to include their comments for the audit group to incorporate into their research.

Account management
In Europe, the AXA XL Claim Account Manager serves the account for both technical and general claim issues. In the US, the Claim Account Manager has overall responsibility for the account relationship and reportable claims are directed technically by AXA XL Senior Claim Specialists.

Scorecards
AXA XL regularly scorecards our TPA partner using these and other criteria to determine if the TPAs are handling claims effectively:

  • Audit scores and trends
  • Quality of data captured in TPA systems
  • How effectively the TPA is resolving data issues
  • How many customer complaints there have been, and the nature and resolution of those
  • Technical team feedback to see how responsive the TPA has been to direction on reportable claims and whether they report claims for oversight in a timely manner

Better support, better customer satisfaction
Our selection and management of our partner TPAs is an involved process. These TPAs are an extension of AXA XL, and often are the entities with the most direct contact with our clients. Our TPAs have a direct impact on the financial health of AXA XL and our clients.

AXA XL works to create strong TPA relationships based on trust and open communication. Our TPAs have the capabilities and the technology to effectively service claims no matter where in the world they occur and have proven they can deliver leading results in response time, customer satisfaction levels, and overall claim outcomes.


About the authors
Aránzazu Arana is AXA XL’s Head of Claims in Spain. Gary Hinson is Head of TPA Claims in North America.


To contact the author of this story, please complete the below form

Invalid First Name
Invalid Last Name
Country is required
Invalid email
Invalid Captcha
 
Subscribe

Global Asset Protection Services, LLC, and its affiliates (“AXA XL Risk Consulting”) provides risk assessment reports and other loss prevention services, as requested. This document shall not be construed as indicating the existence or availability under any policy of coverage for any particular type of loss or damage. AXA XL Risk. We specifically disclaim any warranty or representation that compliance with any advice or recommendation in any publication will make a facility or operation safe or healthful, or put it in compliance with any standard, code, law, rule or regulation. Save where expressly agreed in writing, AXA XL Risk Consulting and its related and affiliated companies disclaim all liability for loss or damage suffered by any party arising out of or in connection with this publication, including indirect or consequential loss or damage, howsoever arising. Any party who chooses to rely in any way on the contents of this document does so at their own risk.

US- and Canada-Issued Insurance Policies

In the US, the AXA XL insurance companies are: AXA Insurance Company, Catlin Insurance Company, Inc., Greenwich Insurance Company, Indian Harbor Insurance Company, XL Insurance America, Inc., XL Specialty Insurance Company and T.H.E. Insurance Company. In Canada, coverages are underwritten by XL Specialty Insurance Company - Canadian Branch and AXA Insurance Company - Canadian branch. Coverages may also be underwritten by Lloyd’s Syndicate #2003. Coverages underwritten by Lloyd’s Syndicate #2003 are placed on behalf of the member of Syndicate #2003 by Catlin Canada Inc. Lloyd’s ratings are independent of AXA XL.
US domiciled insurance policies can be written by the following AXA XL surplus lines insurers: XL Catlin Insurance Company UK Limited, Syndicates managed by Catlin Underwriting Agencies Limited and Indian Harbor Insurance Company. Enquires from US residents should be directed to a local insurance agent or broker permitted to write business in the relevant state.