THIRD-PARTY ADMINISTRATION
TPA Services
Scalable claims and investigative support for third-party administrators, programs, and enterprise partners that require consistent execution, disciplined documentation, and flexible operational capacity.
BUYER LENS
Know what this service should answer before you scope it.
Which part of the claim lifecycle needs capacity, control, review, or orchestration while the client remains the source of authority?
Good reasons to start here
- A program needs assignment-level or recurring operating capacity.
- Multiple claim functions need a common governance and handoff model.
- Quality, routing, escalation, or lifecycle visibility needs stronger structure.
What to have defined
- Program authority, system-of-record ownership, and operating objectives.
- Client guidelines, role boundaries, and escalation ownership.
- The minimum data, evidence, and integration context required for the authorized purpose.
What this should inform
A governed operating path for the file or program without silently transferring claim authority.
ACCOUNTABLE OWNERCarrier or TPA program owner.CAPABILITIES
Disciplined support built around the matter.
MODLAN scopes each engagement to the authorized assignment, applicable requirements, available evidence, and client objectives. Work is documented for clarity, defensibility, and appropriate downstream review.
Investigative program supportClaims workflow supportVendor coordinationDesktop reviewField assignmentsQuality and documentation controls
WHEN THIS SERVICE FITS
Built around a defined operational question.
- A program needs scalable claims or investigative capacity without losing governance.
- Multiple service lines need to be coordinated under one operating model.
- File quality, escalation, and vendor accountability need a common framework.
SCOPE
What the engagement can include.
The exact scope is established by the authorized assignment, applicable licensing or professional requirements, and client guidelines.
OPERATING MODEL
Controlled from assignment through handoff.
Define
Document the authorized program scope, decision rights, escalation paths, and client guidelines.
Route
Direct work to the appropriate claims, investigative, forensic, or intelligence function.
Control
Maintain role separation, auditability, and evidence handling appropriate to the assignment.
Report
Return clear operational status and matter-level findings through the approved channel.
WORK PRODUCT
What the matter can produce.
- Program-aligned assignment handling
- Matter-level documentation and status
- Escalation records where required
- Evidence and work-product references through approved channels
CONTROL BOUNDARY
What keeps the work defensible.
- Client guidelines remain client-specific.
- Regulated work is performed only where authorized and properly licensed.
- Sensitive claim material is not accepted through public website forms.
- Investigative and claims roles are separated where the engagement requires it.
SERVICE FAQ
Procurement and operating questions.
Can MODLAN support only part of a TPA workflow?
Yes. Engagements can be scoped to a defined function rather than requiring an end-to-end program.
Can investigative work sit beside claims handling?
Yes, with role separation and the assignment controls appropriate to the program.
Can MODLAN integrate with existing claims systems?
The platform is being engineered around adapter-based integration so approved systems can exchange authorized data without replacing the carrier or TPA system of record.
Are service levels fixed on this page?
No. Scope, timing, reporting, and service expectations are established in the engagement and client guidelines.
WHERE THIS SITS IN MODLAN
TPA / Claims / Adjusting
Develop and administer the claim record under the client’s authority and guidelines.
Explore the operating family →CLAIMS OPERATIONSTechnology relationship
CST or integration services may add approved intelligence or interoperability, but they do not replace claim authority.
View the full MODLAN service ecosystem →HOW THIS SERVICE CAN SCALE
From assignment to enterprise program—without changing who owns the decision.
A defined objective, scope, owner, evidence/data path, and handoff for a specific matter or task.
Recurring or overflow use of the same capability under established client rules, controls, and escalation paths.
The service becomes one governed lane inside a broader multi-service operating model with explicit dependencies.
PROCUREMENT & IMPLEMENTATION
Questions to resolve before this service enters production.
Enterprise delivery depends on the operating context around the service—not merely the capability itself.
PROGRAM FITTPA Program
Explore program architecture →See how this service can operate inside a broader claims program while client authority remains controlling.
DECISION CONTEXT
This service does not operate in isolation.
The engagement should connect to the correct buyer, adjacent operating layer, and assurance boundary without blurring professional authority or the source of record.
ENTERPRISE JOURNEY
Connect this service to the rest of the operating model.
Move from service selection into the adjacent operational, evidence, integration, assurance, or intelligence layer that the matter actually requires.
MODLAN SYSTEMS
Bring the right people, evidence, and intelligence to the problem.
Contact MODLAN to discuss the authorized scope, geography, timing, and operational requirements for your matter.