Third party administrators process insurance claims on behalf of insurance companies based on contracts. They play an important role in the health insurance sector by providing better services to policyholders. In India, TPAs are regulated by the Insurance Regulatory and Development Authority and must be licensed. The objective of the study is to better understand the current work of TPAs, suggest improvements, gain exposure to workflows, and streamline processes to benefit all stakeholders.

2. Presentation by
INDRAJIT MAJI

3.  Third Party Administrator (TPA) is an organisation
that processes insurance claims on behalf of an
Insurance Company.
 TPA’s normally have a contract with the Insurance
Company in this regard.
 TPA’s play an important role in Health Insurance
sector by ensuring better services to Policy Holders.

5.  In India TPA’s are regulated by Insurance Regulatory
and Development Authority (IRDA).
 It Was introduced in 2001 through TPA – Health
Services Regulations, 2001.
 TPA’s should be licensed by IRDA

6. ID Cards
24 hours customer support services
Cashless Hospitalization
Claim Management

7.  Safeguarding of customer relationships.
 Lower overhead cost and reduced cost of claim
management.
 Improved control over claims outcomes.
 Protection of brand reputation.
 Control of possible frauds by the private healthcare
providers.

8. OBJECTIVE OF THE STUDY
 To study the current working of TPA at Care Hospital,
Hi-Tech City, Hyderabad .
 To get better understanding and to suggest the
betterment options for TPA department.
 To get exposure to the work-flow of the organization.
 To reduce the process which is in favor of all the key
concern of the process cycle

9. There are around 30 TPA’s in India. Few of them are:-
• E Meditek
• Vidal Health (Formerly TTK Health)
• MD India Healthcare
• Medi Assist
• United Healthcare
• East West Assist