Managing Claims Internally: When It Makes Sense to Bring Adjusting In-House
For public entities and risk pools, managing claims is more than just an operational function—it’s about accountability, fiscal responsibility, and delivering fair outcomes to members and stakeholders. Traditionally, many organizations rely on third-party administrators (TPAs) for claims adjusting. But as technology and Claims Management Software evolve, more entities are asking: When does it make sense to handle certain claims internally?
The answer depends on claim type, organizational capacity, and the availability of modern Claims Management Solutions that simplify oversight, reduce complexity, and put powerful tools in the hands of internal teams.
Why Consider Bringing Adjusting In-House?
There are several situations where internal claims adjusting can provide advantages:
- High-Volume, Low-Severity Claims
Workers’ comp medical-only claims, small auto property damage claims, and low-dollar liability incidents are often predictable, repeatable, and manageable internally—especially with Claims Automation Software to streamline intake, documentation, and resolution.
- Specialized Local Knowledge
Public entities often have context that external adjusters don’t. Knowing the facilities, local regulations, and community dynamics can lead to faster resolution and more accurate Risk Assessment for Insurance.
- Oversight and Transparency Needs
Boards, committees, and taxpayers expect visibility. Managing claims in-house with a modern Claims Management Oversight System allows entities to demonstrate accountability and reduce reliance on outside parties for reporting.
- Cost Management
While TPAs are critical for complex and catastrophic claims, the administrative cost of outsourcing small claims can add up. Internal teams supported by Insurance Software Solutions can resolve these more efficiently.
Tools That Make Internal Adjusting Possible
Bringing claims management in-house requires the right technology foundation. Without it, internal teams risk inefficiency and compliance gaps. Fortunately, today’s modern Claims Management Systems are designed to support lean teams at public entities and risk pools.
Here’s what to look for:
1. Core Claims Management Software Capabilities
- FNOL intake (manual and digital)
- Automated claim file creation
- Payments, reserves, notes, and document tracking
- Configurable diaries and task management
These essentials ensure internal adjusters can manage day-to-day claims without needing oversized modules built for commercial carriers.
2. Built-In Oversight and Reporting
Public entities must demonstrate stewardship of public funds. The best Claims Management Oversight Solutions provide:
- Real-time dashboards for managers and boards
- Customizable reports for committee meetings
- Full audit trails and compliance features
3. Accessible AI and Claims Automation Software
Modern Artificial Intelligence for Insurance makes internal claims adjusting smarter and more efficient. The right Claims Management Solution should include:
- Duplicate claim detection
- Subrogation opportunity flagging
- Loss trend detection and severity prediction
- Triage automation for faster resolution
And importantly, this Accessible AI should be usable by business users—without requiring data scientists or complex implementations.
4. Flexibility and Integration
Public entities often rely on multiple legacy systems. That’s why the best Claims Oversight Software offers:
- Easy integration with finance and accounting systems
- Seamless connections to document storage
- Open APIs for data exchange
- Configurable workflows without IT dependency
When to Keep Using a TPA
Not every claim should be handled internally. Catastrophic workers’ comp, high-severity liability, or highly litigated claims still require the expertise and infrastructure of an experienced TPA. In fact, a hybrid approach—outsourcing complex claims while keeping routine ones in-house—often delivers the best balance of efficiency, oversight, and cost control.
Why It Matters for Public Entities and Risk Pools
Public entities and risk pools face unique pressures:
- Serving diverse members with varied needs
- Demonstrating fiscal responsibility to taxpayers and boards
- Providing transparency and accountability
- Managing increasing risk with limited staff
By leveraging modern Insurance Software Solutions and Claims Management Oversight Systems, they can take control of claims that make sense to manage internally—while still relying on TPAs where their expertise is essential.
The Takeaway
Bringing claims adjusting in-house isn’t an all-or-nothing decision. With the right Claims Management Software, Claims Oversight Solutions, and Accessible AI, public entities and risk pools can selectively manage claims that align with their strengths—improving efficiency, transparency, and fiscal responsibility.
“Modern claims management for public entities doesn’t mean replacing TPAs. It means using the right Claims Management Systems and Insurance Software Solutions to decide which claims you can manage best—and having the tools in place to do it effectively.”
If your entity or pool is considering its next step in modernization, now is the time to explore whether internal claims adjusting can deliver value for your organization.
SpearClaims™: Purpose-Built for Public Entities
SpearClaims™ is a next-generation Claims Management Software platform designed specifically for public entities and risk pools—whether you’re managing claims internally, working with a TPA, or using a hybrid model.
When entities decide to bring certain claims in-house, they need tools that balance efficiency, oversight, and adaptability. SpearClaims™ provides exactly that, with built-in claims management oversight solutions that ensure compliance, transparency, and smarter decision-making.
With SpearClaims™, you can:
- Handle FNOL, adjusting, payments, and documentation all within one Claims Management System
- Automate routine tasks with Claims Automation Software to reduce administrative burden
- Leverage Accessible AI for subrogation flagging, risk assessment for insurance, and proactive claim insights
- Conduct self-service audits and track performance with integrated workflow monitoring
- Generate ready-to-share reports for boards, committees, and regulators in just a few clicks
- Maintain a complete audit trail to safeguard public accountability
Conclusion: Smarter Internal Management, Stronger Outcomes
Managing claims internally doesn’t have to mean adding complexity or overhead. With modern Insurance Software Solutions like SpearClaims™, public entities gain the tools to handle claims efficiently while maintaining the oversight and transparency that stakeholders expect.
By adopting a Claims Management Solution with built-in automation, risk assessment for insurance, and Artificial Intelligence for Insurance, entities can turn internal claims management into a strategic advantage.
Schedule a Demo to see how SpearClaims™ can support your team in managing claims in-house.
To explore how this flexible, secure platform can help you reduce leakage, improve recovery, and strengthen your claims oversight process at scale – Request Pricing.
