Help center / Claimsfy TPA

Claimsfy TPA: what it is

Claimsfy TPA

The edition of Claimsfy for a third-party administrator that handles claims for clients: carriers, MGAs, self-insured employers and public entities. It has its own server, accounts and claims. (For an insurance carrier's own claims department, use Claimsfy Carrier.)

What it covers:

  1. Your claims team runs on it:
    • Examiners handle the claims they're assigned.
    • Claims managers (supervisors) see everything, assign and reassign.
    • Intake coordinators receive new claims and send out inspections.
    • Everyone uses the same examiner interface; there's no interface picker. Its tabs are the queue, Notice of Loss, Dispatch, Inspection, Contacts, Policy & Coverage, Financials, Documents, ALE (property claims) and History; there are no Payments, Letters, Notes or Reports tabs. Claims managers, intake coordinators and administrators also get the Received, Metrics, 🌀 Storms and 🏢 Clients tabs.
    • Field adjusters work in Claimsfy Field. Send inspections to your field staff or to independent firms and experts from the Dispatch tab; the inspection comes back to the Inspection tab through the vendor portal or the send-back link.
  2. Each client's rules travel with its claims: handling instructions, service deadlines, reporting schedule and authority show on every claim for that client. See Clients.
  3. Loss funds and loss runs: each client's fund ledger with low-balance alerts and replenishment requests, and loss runs as CSV or PDF or shared to the client portal.
  4. Your clients get a portal. Client users sign in to follow their claims, download what you share (including loss runs), message the examiner, approve authority and send new claims. Each client sees only its own claims. It's on by default.
  5. Claim deadlines (⚖) by the loss state's rules and each client's standards, and storm events (🌀) with live claim counts by state.
  6. The back office runs here too: adjuster onboarding for W-2 employees and 1099 contractors, a filing system, billing per client with fee schedules and time & expense, receivables, payables and vendors, and payroll with files for your payroll provider and bank. See Back office.