CLAIMS OVERSIGHT · FOR CARRIERS, CAPTIVES AND SELF-INSUREDS
Claims Oversight When Someone Else Does the Handling
A TPA handles the claims, but the losses, the reserves and the report to your board are still yours. On VCA ClaimsCore your team gets its own seat on those claims, so a question about one starts with the claim, not the next loss run.
Your own team handles the claims? Claims Software for Captives and Self-Insureds → Running a captive? Claims Software for Captives →
A TYPICAL OVERSIGHT PACKAGE
ClaimsCore, and What an Oversight Team Adds to It
A typical oversight package adds VCA Insights to ClaimsCore for reporting across the book. ClientPortal and DataBridge are added where the work needs them.
Typical for Captives and Self-InsuredsClaimsAI: Works Inside the Core for Every SeatNot Typical for This Seat
- VCA ClaimsCoreWhere every claim is workedClaimsAI™Works inside the claim, on the core.
- VCA InsightsAnalytics across the book
- InsuredConnectNot typical for this seat
- PolicyConnectNot typical for this seat
- DataBridgeNot typical for this seat
- ClientPortalNot typical for this seat
- ClaimsPayNot typical for this seat
- LloydsConnectNot typical for this seat
ClaimsCore is complete on its own. Each add-on joins it when the work needs it.
Not Typical for This Seat
YOUR TPA'S SEAT
Works the Claim
- In your VCA account, as a claims team
- Or in the system it already runs
The handling stays with your TPA
Agreed in Discovery
YOUR SEAT · VCA CLAIMSCORE
The Claims You Answer For
WHERE YOUR TPA WORKS IN YOUR ACCOUNT
- Every reserve movement, with who made it and why
- The authority limit each of your TPA's adjusters works under
ADDED FOR OVERSIGHT
- Scheduled reports to leadershipVCA Insights
- A login for your auditorsClientPortal
YOUR OWN WAREHOUSE, IF YOU RUN ONE
Claims Data Out, on a Schedule You Set
DataBridge, an add-on
Handling some claims in house, or writing the programs yourself? Start on the page for that work: TPAs, MGAs, carriers or the Lloyd's market. How a self-insured moved its own claims desk onto ClaimsCore →
WHERE YOU SIT
You're accountable for claims you can't always fully see, across people and partners you don't control.
FROM YOUR SEAT
What does your team see from its own seat?
Your TPA keeps the handling. Where it works on VCA, each claim carries its reserve history and runs under the authority limits set for each adjuster, and your team reads it from its own VCA account. VCA Insights builds the report that goes up.
- Every Reserve MovementTransactional reserve history records each reserve movement on the claim with the date, who made it and the reason given.Audit Trail on ClaimsCore →
- The Limits Your TPA Works UnderLimits are set for each user, with your reporting requirements attached. Where your TPA works on VCA, its adjusters work under them.Authority Limits on ClaimsCore →
- Reporting UpVCA Insights, added to ClaimsCore, tracks caseloads, reserve usage, and first-contact and reporting deadlines against thresholds you set, drills down from a program to an individual claim in one click, and sends scheduled reports to leadership.VCA Insights →
Also an add-on: ClientPortal, a branded login for your auditors and the carriers you report to, showing the claims that concern them, including who changed each reserve and why. ClientPortal →
WHEN YOUR TPA WORKS ON VCA
A reserve above an adjuster's limit stops for approval
- Reserve Above the LimitYour TPA's adjuster enters a reserve beyond their own authority.
- Stopped for ApprovalClaimsCore asks whether to submit it for approval.
- Routed to an ApproverThe request goes to the approver chosen from a list.
- Waiting for ApprovalThe request shows under Pending Approvals.
- Noted on the ClaimA note records who the request went to.
YOUR TPA'S SIDE
Does your TPA have to change systems?
No. Your TPA can work on VCA or keep the system it runs today.
YOUR TPA WORKS ON VCA
Inside your VCA account
Your TPA can work your claims as a claims team inside your VCA account, under the authority limits set for each of its users.
YOUR TPA KEEPS ITS OWN SYSTEM
What reaches you is agreed first
Your TPA keeps working in the system it runs today, and what reaches your account is settled before anything is configured.
Agreed with you and your TPA in discovery, before anything is configured: which claim data reaches your account, how often it arrives, and who builds the connection where your TPA keeps its own system.
THE REPORT AND THE CLAIM
Start from the claim, not the extract
A loss run or a bordereau describes a period that has closed. It shows where the book stood, not which claim is getting worse now.
When the report is the only channel, oversight is always reading history, and the answer to your board's question has to be assembled from extracts. With the claims in your own account, you open the claim when the question comes up.
ON THE CLAIM, ALREADY RECORDED
- Reserve Moved
- Diary Missed
- Above Authority
- Still No Contact
Four events on the claim, on the record in the account it is worked in.
ON THE REPORTING CYCLE
- Read from the report alone, the same four events surface only when it lands.
- The ReportALL FOUR, AT ONCE
The report still goes out on its cycle. Your question starts at the claim.
WHY VCA
What Stands Behind Your Seat
Your team gets its own seat on the claims, and the handling and the systems around it stay where they are.
- Depth of Claims ExpertiseWe know claims from every seat we work with, including the TPA desk your claims sit on and the seat that answers for them. Several client relationships have run longer than ten years.Why VCA →
- Speed of ImplementationDiscovery comes first: VCA maps your TPA arrangements, authority levels and reporting lines, and configures ClaimsCore to them. The timeline for your arrangement comes out of that work, in weeks, not years.
- Capital EfficiencyClaimsCore on its own gives your team its seat on the claims. VCA Insights, ClientPortal and DataBridge are add-ons you take when that job comes up. Nothing is ripped out: your seat sits beside the systems you and your TPA already run.
Questions Claims Oversight Teams Ask
What is claims oversight software?
Software that gives the organization funding the losses its own seat on the claims a TPA or adjusting firm handles: the reserve history on each claim, the authority limits it is handled under, and the reporting that goes up to leadership. On VCA it is VCA ClaimsCore, with add-ons such as VCA Insights and ClientPortal for reporting and for the people you report to.
Our claims are handled by an independent adjusting firm rather than a TPA. Does this still apply?
Yes. What matters is the system the firm runs, as with a TPA. Which claim data reaches your VCA account, how often it arrives, and who builds the connection are agreed with you and the firm in discovery, before anything is configured.
Our TPA also handles workers' compensation for us. Is that covered?
No. VCA supports every property and casualty line of business, but not workers' compensation or health benefits claims. Oversight on VCA covers the property, casualty and specialty claims your TPA handles; workers' compensation claims stay outside it.
Can we get our claims data out of VCA into our own systems?
Yes, with DataBridge, an add-on for teams that run a data warehouse of their own. It delivers your claims data there on a schedule you set, with no connectors for your team to build. You do not need a warehouse to oversee claims on VCA: VCA ClaimsCore, ClientPortal and VCA Insights work without one.
How long does it take to set up claims oversight on VCA?
Every VCA implementation starts with discovery: VCA maps how your claims move, including authority levels, reporting obligations and the handoffs to your TPA, before anything is configured. On a Standard License, configured to your workflows, VCA ClaimsCore is live in 3 to 4 weeks; an Enterprise License deployment takes 8 to 16 weeks, and a Carrier License deployment 12 weeks to 6 months. Which band fits depends on your arrangement, and discovery settles it before configuration starts.
What should we get in writing before we sign?
Service levels (uptime, support response times, backup cadence and service credits) and the format, timeline and cost of returning your claims data at the end of the agreement. Put the same questions to every vendor you compare.
Does VCA handle claims itself?
VCA's business is claims management software, and only that. It has no adjusting arm, no TPA division and no claims services business, so the handling stays with your TPA.
See the claims you answer for
Bring your TPA arrangement and the reports your board expects. In the demo:
- Reserve history on a claim, with who moved each reserve
- Authority limits set for your TPA's adjusters, and the approval step when a reserve goes above one
- A program report, drilled down to one claim