Integrated Payor Solutions

Fast forward implementation timelines and elevate valuation with the platform investors trust.

Remember when apps were seen as nice-to-haves? That’s no longer the case, especially when members expect features that most apps offer, like real-time updates. In my latest blog, we’re looking at the non-negotiable tech expectations of today’s industry, from apps to access (and why they’re vital to member experience). Read the full blog: https://hubs.ly/Q03KZvtR0

Insights and solutions into managing claims admin with confidence.

Scaling a TPA is rarely just a technology problem. The real work starts when a new system reveals the operational issues that have built up over time. Legacy processes, inconsistent information, and manual workarounds can all become harder to ignore once an organization begins preparing for growth. A new platform may bring those issues to the surface, but solving them requires more than software. It takes a partner willing to understand how the TPA operates, build around its actual needs, and remain involved as the organization adjusts after go-live. I’ve seen firsthand how much of a difference that approach makes. In my latest article, I share what partnership looked like during a recent implementation and why technology alone, although a key piece, is not enough to help modern TPAs scale. https://hubs.ly/Q04stFTt0 When you evaluate a new platform, how much weight do you give the partnership behind it?

I've never been interested in adding technology simply for the sake of it. The opportunity has always been finding practical ways to improve the work our teams do every day. That's why we've incorporated AI into our implementation process. It reviews uploaded plan documents, identifies the key information needed for plan setup, and creates configured plan builds before our implementation team takes over. Here’s what that looks like in practice.

I recently sat down with Louise Tanski, Co-Founder of Amera (YC F25), to talk about where AI is headed in the TPA space. AI is going to have a major impact on this industry, especially when it comes to repetitive workflows. A well-trained agent can help teams move faster, triage more efficiently, and give experienced people more room to focus on the claims and decisions that require their judgment. For TPAs, that creates a real opportunity to improve efficiency and expand capabilities without adding unnecessary operational strain. However, AI is only as useful as the foundation it’s built on. Quick implementation, a truly cloud-based platform, and built-in compliance infrastructure for regulations like the No Surprises Act (NSA) and Transparency in Coverage (TiC) Rule all play a role in helping organizations modernize in a way that works in practice.