Why More Organizations Are Implementing Their Own Claims Management Systems – Even When Using a TPA  

Outsourcing claims administration to a Third-Party Administrator (TPA) has long been a practical strategy for Public Entities & Risk Pools looking to reduce operational overhead. But as expectations for transparency, speed, and cost control increase, highlighting the need for better claims management oversight, more risk managers and claims leaders are rethinking the technology behind those partnerships. 

A growing number of organizations are choosing to implement their own claims management software—even while continuing to work with TPAs. The goal isn’t to take back the work, but to gain better oversight, accountability, and strategic control. 

Here’s why this shift is happening, and what you need to consider if you’re thinking of managing your claims through your own P&C claims system. 

The Problem: You Can’t Control What You Can’t See 

For many organizations, relying solely on the TPA’s technology means limited visibility into claim progress, recovery opportunities, financial leakage, and long-term trends. The TPA owns the data, controls the workflows, and sets the reporting cadence. That can leave clients in the dark—reactive instead of proactive. 

That’s where a customer-managed core system comes in. 

The Solution: Take Ownership of the Platform—Without Taking on the Admin Work 

By implementing your own P&C claims software, your organization can retain control over the data, workflows, and reporting—while still outsourcing the day-to-day administration to your TPA. This hybrid model puts you in the driver’s seat, providing the necessary insight that allows you to improve claims visibility without increasing headcount. 

Key Benefits of Running Your Own Claims Management System 

• Full Data Ownership and Transparency 

With your own claims management software, you don’t wait on reports or data extracts—you get real-time access to every claim, note, payment, reserve, and outcome. It’s your data, structured your way. 

• Custom Rules and Workflows 

No more one-size-fits-all processes. Use low-code platforms to define your own triage rules, approval thresholds, and escalation paths. The TPA follows your workflows inside your system. 

• Built-In Oversight for TPAs 

Monitor TPA performance in real time with dashboards, activity tracking, and SLA alerts. It’s not just about managing claims—it’s about managing your vendor with confidence through improved claims management oversight. 

• Reduce Claims Leakage 

Advanced claims leakage prevention solutions and AI help identify inconsistencies, missed subrogation, duplicate payments, or over-reserving. You can catch issues early—without relying solely on the TPA to surface them. 

• Centralized Reporting Across All Claims 

Whether you use one TPA or five, across multiple regions or entities, your modern insurance core platform unifies all claims data in one place. That means consolidated insights, better benchmarking, and smarter decision-making. 

• Streamline Subrogation 

Use integrated subrogation solutions to track recoverable claims, measure results, and ensure your TPAs are pursuing every viable opportunity. 

When It Makes Sense to Bring in Your Own System 

• You’re managing a large claims portfolio across multiple TPAs or business units 
• Need for Improved oversight, reduction in leakage, and optimized outcomes 
• Customized reporting and analytics not available in the TPA’s system 
• Regulatory, compliance, or audit requirements that demand stricter control 
• To future-proof your claims operation with automation, AI, and integration capabilities 

What to Look For in a Client-Owned Claims Management System 

If you’re considering bringing in your own system, look for a platform that supports: 

• Low-code customization for fast rule and workflow changes 
• Flexible intake and triage tools that align with your operations 
• Real-time dashboards and custom reports for client-side visibility 
• Claims automation software with built-in AI for fraud, triage, and leakage detection 
• Multi-client or multi-TPA capabilities, if you’re managing multiple relationships 
• Seamless integration with your HR, ERP, legal, and finance platforms 

The Outcome: Strategic Claims Management Oversight, Not Just Administration 

When your organization owns the P&C claims system, you’re no longer dependent on your TPA’s limitations. You gain real-time control, improved accuracy, and actionable insights. You reduce the risk of missed subrogation, slow responses, or overpayments. Most importantly, you move from passive oversight to active management. 

It’s not about replacing your TPA—it’s about enabling them to work within your ecosystem. You keep the partnership but take back the power. 

Final Thought: A TPA Is a Vendor—Your Claims System Is a Strategic Asset 

Bringing your own claims management software doesn’t mean doing the work yourself. It means treating claims oversight as a strategic function—one that deserves the same level of investment, control, and intelligence as your financial or operational systems. 

In a world where every claim counts, that kind of visibility is no longer a luxury—it’s a competitive advantage. 

Example: A TPA Greatly Improves Efficiency by Leveraging Low-Code/No-Code 
A business user successfully deployed 12 AI models—without a developer—to automate tasks previously being done manually, and is now successfully reading invoices and indexing them to claim files, entering payments based on invoices, processing documents, and summarizing notes, leading to measurable efficiency gains. |
This TPA is a current Spear client leveraging SpearClaims™ 

The Bottom Line: Flexibility and Speed Are Now Mandatory 

The future of claims management oversight lies in platforms that are: 

• Agile 
• Scalable 
• Configurable by business users 
• Built on low-code/no-code frameworks 

Whether you’re upgrading from spreadsheets or replacing legacy systems, choose a claims management software solution that evolves with your needs and empowers every stakeholder. 

Discover the smarter way for Public Entities & Risk Pools to improve claims management oversight.   

Schedule a Demo to see first-hand how SpearClaims™ will enable your organization to accelerate and simplify claims processing.   Built by industry experts on a modern low-code/no-code platform, SpearClaims™ is a future-ready claims management software solution that delivers the power of built-in AI and Analytics while checking all the boxes. 

To discover how Spear’s solutions are accessible to insurers of all sizes, Request Pricing.