Third Party Administrator (TPA) Services
What Is a Third Party Administrator?
A Third Party Administrator (TPA) manages insurance claims, benefits plans, or risk programs on behalf of self-insured employers or insurance carriers — handling the day-to-day administrative work so businesses don’t have to build that expertise in-house.
Gilbert’s Risk Solutions is an outsourced claims administration solution for employers that self-insure their workers’ compensation program. Our TPA relationship is licensed in the Commonwealth of Pennsylvania. It makes sense to outsource claims, both for the expertise and because maintaining an in-house claims operation is prohibitively expensive for all but the largest employers.
Gilbert’s expert claims team can take the headache out of your workers’ compensation administration and help control your costs. We take a risk management, consultative approach to our services — partnering with you to identify and mitigate risks, employing best practices in claims administration, and working toward the optimal resolution of every claim.
Workers’ comp claims are time-sensitive, complex, and sometimes contentious, requiring three-way communication among the employer, the employee, and the treating physician. Today, average claim costs run 40% wage replacement and 60% medical costs — which is why we’ve built specialized expertise in managing the growing medical component of every claim.
TPA Services We Offer
- Timely Benefits Administration and Check Issuance
- Completion of Annual Accident/Illness Workers’ Comp Bureau Report
- Actuarial Analysis
- Pre-, During & Post-Injury Best Practices
- Supervisor Training
- Loss Control & Safety
- Claims Reporting Process & Intake
- Pre-Claim Qualifications
- Timely Accident Investigations
- Determination of Work-Relatedness; Compensability
- Denial of Non-Compensable Claims
- 3-Point Communication
- Fraud Surveillance
- Scheduling of RN and Medical Management Services
- Scheduling of IME
- Medical Bill Repricing
- Completion of 1099
- Transitional Return-to-Work Planning
- Recommendations of Settlements
- Subrogation
Who Benefits from TPA Services?
TPA services are especially valuable for self-insured employers, associations, and large businesses managing their own risk programs — anyone who wants the cost savings of self-insurance without building an in-house claims department from scratch.
Our Goal Is Timely Claim Management to Optimal Resolution
Hours and days can add up to huge costs in workers’ compensation claims. It’s essential to bring best practices and processes to bear on every claim, from intake through resolution.
When a Claim Occurs
When a claim occurs, we work aggressively to control your costs by establishing and maintaining communication with the employer, the injured employee, and the medical provider — advising all parties objectively toward a safer work environment and timely claims resolution.
Our Team
Our highly experienced team includes every discipline you need for success: claims management, risk management, loss control, data analysis, nurse case management, HR, and more. We work closely with your internal risk manager, HR staff, and supervisors to implement best practices — all with the goal of helping injured employees return to work quickly, reducing losses, and mitigating exposures.
Our RISK SHIELD® Process
Most Fortune 500 companies have a full-time risk manager, but few small- to mid-size businesses can afford that luxury. With Gilbert’s Risk Solutions, you get a risk manager on your team through our proprietary RISK SHIELD® Process – proactive, diagnostic, and consultative, rather than just reactive insurance placement. We’ve been helping area businesses control their risks and protect their bottom lines for seven generations.
CONSULT
DESIGN
BUILDING
MAINTAIN
Third Party Administration FAQs
A TPA handles the administrative and operational side of claims and benefits management — including claims intake, medical management, return-to-work coordination, and reporting — on behalf of a self-insured employer.
Self-insurance tends to make the most sense for larger employers with stable, predictable claims history and the financial reserves to absorb variability in claims costs. A risk assessment can help determine if it's a fit for your organization.
Stop-loss insurance protects self-insured employers against catastrophic claims beyond a certain threshold, while the TPA manages day-to-day claims administration — the two typically work together as part of a complete self-insurance strategy.
Key metrics include claim resolution time, medical cost management, return-to-work rates, and overall cost containment compared to industry benchmarks.
