TPA & claims attribution
What a TPA is
Section titled “What a TPA is”A Third-Party Administrator (TPA) is an entity that performs insurance administration functions — especially claims handling/adjusting — on behalf of an insurer or self-insured plan, without bearing the underwriting risk itself. A TPA processes, investigates, and settles claims for a fee. STABLE
This is Glacis revenue stream #3: use Glacis’s cryptographic attribution to do claims error-source attribution (which model/decision caused a loss) and earn claim-adjusting revenue. GROUNDED · Glacis
Where it sits relative to the MGA
Section titled “Where it sits relative to the MGA”The MGA, the carrier, and the TPA are distinct roles that can overlap:
An MGA can also hold delegated claims authority — see 04 What is an MGA — in which case the MGA performs a TPA-like function. The licensing/registration to act as a TPA or claims adjuster is separate from the producer license. STABLE
Claims attribution = the Glacis angle
Section titled “Claims attribution = the Glacis angle”When an AI system contributes to a claim outcome (e.g., an automated denial that turns out to be wrong, or an algorithm alleged to discriminate), the live question is which decision, by which model, caused the loss? Cryptographic attestation of AI decisions makes that question answerable — turning “we think the model did X” into “here is the attested record of what the model did.” GROUNDED · Glacis
This maps directly onto two things the exam and the regulators care about:
- Unfair claims settlement practices — the body of law governing how claims must be handled (no unreasonable delay, proper investigation, good-faith settlement). See 12 Ethics & trade practices. STABLE
- AI claims litigation — Kisting-Leung v. Cigna (AI denials without proper review) and Kelly v. State Farm (alleged discriminatory claims algorithms) are exactly the disputes attribution evidence speaks to. See 02 AI claims litigation. GROUNDED · Law360
Why regulators reward attribution
Section titled “Why regulators reward attribution”The NAIC’s emerging third-party data and models oversight pushes insurers toward documentation of model origins and explainability. A TPA whose claims decisions come with attested, attributable evidence is pre-aligned with where the rules are heading — compliance becomes a product feature. See 01 AI evaluation tool & third-party WG. GROUNDED · Law360
How it ties the three streams together
Section titled “How it ties the three streams together”The TPA stream closes the loop: the same evidence that helps price and bind risk (the MGA) also helps attribute and adjust claims (the TPA). See 01 The flywheel.