Who hires the independent third-party administrator (TPA) to provide claims services?

Who hires the independent third-party administrator (TPA) to provide claims services?

• A. The insured
• B. The insurer
• C. The employer
• D. The government

Answer: (A)

The key idea is that a third-party administrator is brought in to handle claims processing for whoever owns and controls the plan. In this context, the insured is the policyholder who delegates claims administration to an independent TPA to manage intake, adjudication, and payment of claims on their behalf. The insurer is the carrier that provides the coverage, but does not typically hire the TPA. Government involvement is not part of private plan administration. So, when the question emphasizes who contracts with the TPA to provide claims services, the insured is the party taking on that administrative arrangement.

The key idea is that a third-party administrator is brought in to handle claims processing for whoever owns and controls the plan. In this context, the insured is the policyholder who delegates claims administration to an independent TPA to manage intake, adjudication, and payment of claims on their behalf. The insurer is the carrier that provides the coverage, but does not typically hire the TPA. Government involvement is not part of private plan administration. So, when the question emphasizes who contracts with the TPA to provide claims services, the insured is the party taking on that administrative arrangement.