Are you a small to medium sized regional employer? Do you retain some of your workers’ compensation risk? Are you tired of the same old status-quo regarding your WC claim handling options? Forget the conventional assumption that regional employers are small fish in a big broker pond. Forget that your TPA options seem limited to the few large “big-box” vendors who partner in most brokerage businesses. Here is a secret: you don’t have to take it anymore! There are alternatives!
First, let us establish that much of the frustration in any employer’s WC claim program stems from the operational standards of the large TPAs. Their procedures include fast-tracking claims, utilizing less human contact, and applying one-size-fits-all automation. If you ask most employer-side WC professionals who have changed TPAs in the past 5-10 years, many will opine that the major TPA players are simply different heads on the same monster.
Unfortunately for national or multi-state employers, their TPA choices are limited to the usual big-box vendors. Only the few very savvy and very large employers extract true specialized service from their large TPA. The others are left with little option but to endure the assembly line claim handling process which is, at best, hit or miss in providing good claim-by-claim results. As far as those adjusters working their way through the ranks at large TPAs, they will only know data-screen driven processing with minimal emphasis on personal attention in adjusting WC claims. This is a perfect storm for perpetual mediocrity in satisfaction and results, and diminishing the adjuster talent-pool.
There are Better Options than National Vendors
Regional employers have the advantage of skipping the big-box vendors and partnering with a customer-focused TPA provider. Here are some advantages to selecting a customer-focused TPA:
#1 Dedicated team of experts
TPAs who make customer satisfaction a priority have highly skilled and seasoned experts to handle your employee's claims. They will use the RFP process to personally sell their team of specialists, and will ignore the common bells, whistles and marketing smoke-screen of the big players.
#2 Partnership
Customer-focused TPAs will want to spend time at your location to absorb the nuances of your risk and workforce. They will provide an intelligent partnership concept rather than a predictable, canned proposal-template document.
#3 Hand-selected Industry Veterans
Your customer-focused TPA partner is staffed by hand-selected industry veterans who purposely chose to abandon the large TPA assembly-line to pursue “real” adjusting at a smaller company. If you have ever asked, “Where have all the good adjusters gone?”, you might check these smaller, customer-focused TPAs!
#4 No Hidden Fee-sharing
Customer-focused TPAs can give you real price options that do not include confusing and often hidden fee-sharing medical administration relationships. As a result, you receive outcome-based service that has no cross-incentive to churn your claims.
#5 Concierge Services Provided
Customer-focused TPAs can provide special service to the nuances of your requirements. This goes far beyond “best practices”, and well into the realm of concierge-level service. Small players are nimble and adaptable with no red-tape, and can do what major TPAs can’t or won’t do. Here are some examples of what the local customer-focused TPAs can do:
-
Adjust claims in your existing claim system to prevent the burden and cost of data transfer
-
Take on those few odd-ball legacy claims from different programs as part of a single going-forward TPA contract
-
Assign local adjuster visits or office hours on your site
-
Support extended person-to-person requirements to hand-hold your employees in the claim intake process, return to work effort, and claim closure. In the correct scenario, an adjuster as personal partner can minimize the need for nurse intervention and directly build needed confidence in the program and the process.
-
Maintain the context of your WC program as a branded employer initiative. The adjuster presence can be depicted in whatever mode that supports the employer’s mission in occupational health and safety.
Conclusion
There are some potential roadblocks when selecting a customer-focused TPA, but none are insurmountable. Most important is to avoid any TPA operation with a high-volume, low-cost approach. Expect to pay slightly higher fees, but be confident in the value and long-term savings from a customized partnership. Enlist your broker’s support in finding a smaller, customer-focused TPA or search on your own via local RIMS or other organizations or with the help of a consultant.
If your broker resists this approach, remember that as an employer and customer, you need to leverage your position and demand to explore your options. Workers’ compensation is probably not the only line at stake here for your broker. As a viable resort, you can always fire them and play a similar strategy in finding a smaller broker who will be more adaptable to your needs.
