Workflow · Claims
TPA / Carrier Performance Analysis
Evaluates how well a TPA, carrier, or claims administrator is performing across claims handling, service levels, financial outcomes, communication, compliance, reporting, and partnership — category by category, with evidence-graded ratings — and produces a stewardship-ready report. Works from standard categories or your own scorecard/SLA/contract. You confirm every rating.
What goes in
What's being reviewed, the review period and scope, your own scorecard/SLA/rubric if any, and supporting reports (loss runs, stewardship, SLA, claim notes).
What you get
A TPA/Carrier Performance Review report: scorecard, strengths, concerns, claims-outcome and service-level analysis, data-quality findings, and a client-facing summary.
How it works
- 1Define the review: standard categories or your own scorecard/SLA/contract, plus the vendor, period, scope, and whether you want scores, narrative, or both.
- 2Evidence intake: upload loss runs, stewardship reports, SLA reports, and claim notes — or run a judgment-based review clearly flagged as such.
- 3Category-by-category review: for each category SoterAI shows the evidence, computes relevant metrics, and proposes a rating for you to confirm.
- 4Report: it assembles the scorecard, strengths, concerns, claims and service analysis, and a polished client-facing summary.
Related pages
What this workflow delivers
A TPA/Carrier Performance Review report: scorecard, strengths, concerns, claims-outcome and service-level analysis, data-quality findings, and a client-facing summary.
3+ hours
- Guided step by step, no blank page
- Owners and follow-up on every run
- Human review before sign-off