TPA Technology & Operations, Built to Perform

From business process outsourcing, to configuration and plan builds, to implementations and operational optimization, Netmark brings comprehensive solutions that help TPAs move faster, operate smarter, and scale with confidence.

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WHAT WE DO

What We Do

Whether implementing a new platform or optimizing a long-standing system, Netmark helps TPAs launch faster, reduce costs, and scale without operational bottlenecks.

CONTACT SALES

Core BPO / BPaaS / Operations Services

Run your TPA operations faster, leaner, and more efficiently. From claims processing to customer support, we handle the heavy lift—reducing costs, improving accuracy, and freeing your team to focus on growth.

  • Medical, dental, vision, and Rx claims processing
  • Claims adjudication (auto-adjudication and manual review)
  • COB (Coordination of Benefits) processing
  • Subrogation and recovery
  • Claims audit and payment integrity
  • Configuration and Benefit Plan Assessment, Audit, and Remediation
  • Configuration and Plan Build as a Service
  • Benefit/coverage code configuration
  • Adjudication logic mapping
  • Auto-Adjudication Improvement Assessment
  • Member enrollment and termination processing
  • Open enrollment support
  • Dependent verification
  • COBRA administration
  • ACA compliance management
  • Provider credentialing and contracting support
  • Network maintenance and roster management
  • Provider dispute resolution
  • Directory management
  • Call center / contact center services (members, employers, providers)
  • EOB (Explanation of Benefits) support
  • Grievance and appeals handling
  • Multilingual support services
  • Full back-office ecosystem
  • Claim system, claims processing, audit, configuration, plan build, customer services, etc.
Core BPO / BPaaS / Operations Services

Implementation Services

Launch with confidence. Netmark handles every aspect of your TPA system implementation—from platform configuration to claims setup—ensuring your operations are accurate, compliant, and ready to scale from day one.

  • TPA platform setup and configuration (e.g., VBA, Javelina, WLT, Plexis, and many others)
  • Benefits plan build and enrollment setup
  • EDI/834 and other data integration setup
  • Claims adjudication engine configuration
  • Provider network and fee schedule loading
  • Legacy system data extraction, transformation, and loading (ETL)
  • Member, claims, and provider data migration
  • Historical data conversion and validation
  • API and middleware integration with carriers, employers, and vendors
  • Pharmacy Benefit Manager (PBM) integration
  • Stop-loss carrier connectivity
  • EHR/EMR and provider portal integration
  • UAT (User Acceptance Testing) support
  • Claims testing and parallel processing runs
  • Regression testing and go-live readiness
Implementation Services

Financial & Compliance Services

Stay financially accurate and fully compliant without added complexity. Netmark supports billing, reporting, and regulatory requirements with precision—helping you reduce risk, improve visibility, and maintain confidence across your operations.

  • Invoice generation and billing reconciliation
  • Premium collection and employer billing
  • Contribution management
  • Claims payment reconciliation
  • Reserve and IBNR calculations
  • Stop-loss reporting and reimbursement
  • Regulatory and statutory reporting
  • HIPAA compliance management
  • ACA, ERISA, CMS 111, RxDC, and DOL reporting
  • State and federal filing support
  • Audit support (internal and external)
Financial & Compliance Services

Specialty & Value-Added Services

Extend your capabilities without expanding your team. Netmark delivers specialized services that enhance performance, improve outcomes, and add strategic value across your TPA operations.

  • Utilization Management (UM) support
  • Precert and Prior Authorization
  • Flexible Spending Account FSA/HRA
  • HSA Administration
  • Wellness Program Administration
  • Subrogation and recovery services
  • Fraud, Waste, & Abuse (FWA) detection
  • Start-up TPA support services
Specialty & Value-Added Services

Ongoing Managed Services

Keep your systems running smoothly and your operations continuously improving. Netmark provides ongoing support, optimization, and analytics to keep your TPA environment stable, efficient, and ready to scale — turning your data into actionable insights that help you monitor performance, control costs, and make smarter decisions.

  • Application management and support (AMS)
  • System upgrades and patch management
  • Continuous process improvement (Lean/Six Sigma)
  • SLA-driven performance management
  • Disaster recovery and business continuity support
  • Data Warehouse hosting and support
  • Population health and utilization reporting
  • Claims trend and cost analysis
  • Employer/plan sponsor reporting packages
  • Predictive analytics for risk management
  • Standard and custom reporting dashboards
Ongoing Managed Services

THE NETMARK VALUE

Reduce Costs While Improving Performance

A smarter way to implement, integrate, and scale your TPA operations.

Netmark replaces inefficient processes, costly rework, and fragmented vendor support with a streamlined, expert-driven approach that delivers measurable savings.

20–40% Faster

BPO Implementation Timeline

Reduce timeline to delivery of full back-office services.

Lower Overhead

Reduce internal staff costs

Minimize internal strain.

Fewer Errors

First-Time Right Config

Improve accuracy from day one.

Eliminate Rework

Clean Delivery Execution

Avoid costly corrections.

Built to Scale

No Added Fixed Costs

Grow without increasing overhead.

Ready to Streamline Your TPA Operations?

Let's reduce complexity, cut costs, and get your systems performing at their best.

See How Much You Can Save

FROM THE BLOG

Stay Informed & Inspired

Stop Assuming Your TPA Works for You — Unpacking the TPA Role in Self-Funded Plans How We Are Rebuilding Health Plan Supply Chains Hidden Costs in Your Health Plan — How to Separate True Value from Vendor Margin

COMMON QUESTIONS

TPA FAQs

A Third-Party Administrator (TPA) is an organization that manages health plan administration and claims processing on behalf of employers, health plans, and self-funded groups. TPAs help streamline operations, improve accuracy, reduce administrative burden, and enhance the member and provider experience.

We provide a full range of TPA support services, including claims administration, configuration and benefit setup, eligibility management, provider data maintenance, audit and quality assurance services, payment integrity support, process improvement, and operational consulting. Our solutions are designed to help organizations improve efficiency, reduce costs, and scale effectively.

Before scaling, during growth periods, or when backlogs and errors increase.

Our team focuses on operational accuracy, workflow optimization, and process efficiency. By identifying bottlenecks, reducing rework, improving turnaround times, and strengthening quality controls, we help clients lower administrative costs while improving service levels and claims outcomes.

Yes. We work within existing systems, platforms, and operational structures to enhance performance without disrupting day-to-day operations. Our team has experience supporting a wide range of claims administration platforms, configurations, and business processes across the healthcare and TPA industry.

We partner with TPAs, self-funded employers, health plans, provider organizations, and healthcare service companies seeking operational support, process improvement, or scalable administrative solutions. Our services are tailored to each client's unique goals, compliance requirements, and growth strategy.