Solutions · Third-party administrators
Claims software for TPAs: more files per adjuster, same headcount
Intake, evidence, coverage and recovery run per program, with an audit trail your client can read.
In short
Hesper AI is an AI claims resolution platform used by third-party administrators to run more claims per adjuster without adding headcount. Its agents handle intake extraction, evidence assembly, coverage analysis, demand review and recovery screening across client programs, and every decision carries a sourced audit trail that stands up in a client audit. Your adjusters keep the decisions.
Why does per-file economics decide a TPA's margin?
A TPA is paid per claim, per program, or per head, and the cost side is almost entirely adjuster time. Margin is therefore the number of files an adjuster can carry at the service level the contract promises. Hiring your way to volume moves the revenue line and the cost line together.
Automation only helps if it removes the work that fills the day: reading the notice, chasing records, assembling the file, checking the billing, writing the summary. That is the work Hesper's agents do.
How does it handle many client programs at once?
Each program gets its own rules: which claims resolve straight through, what routes to which desk, what the client requires in a file, what the reporting looks like. The agents apply those rules per program rather than averaging them.
Because every action is logged with its source and timestamp, program reporting and client audits draw on the same record the adjuster worked from, rather than a reconstruction after the fact.
What happens in a client audit?
A client auditor pulls files and asks why each decision was made. The answer is either in the file or it is not. Hesper writes the reasoning as the claim runs: what evidence was gathered, what it showed, what was recommended, and who signed it.
That is the same record that supports a carrier partner's review of a delegated program, and the reason MGAs use it for capacity audits.
How long does it take to stand up, and on whose systems?
Hesper connects to the claims system you already run through its API, and can start on one program rather than the whole book. It can take a claim at first notice or pick one up mid-stream for file review, demand review or recovery screening.
No rip-and-replace, and no requirement that your clients change systems.
What does Hesper do, and what does your team decide?
| Hesper's agents | Your team |
|---|---|
| Extracts intake and builds the file across programs | Owns the client relationship and the SLA |
| Applies each program's rules consistently | Sets the rules per program |
| Writes the sourced audit trail as the claim runs | Answers the client audit |
| Screens every file for subrogation and salvage | Decides what to pursue for the client |
What does the output look like?
- Program
- Client with its own reporting requirements and a defined straight-through policy
- Intake
- First reports arrive by email and portal, extracted into the claims system
- Evidence
- Medical records assembled, timeline rebuilt, duplicate billing flagged
- Recovery
- Third-party liability identified on a subset of files and ranked with evidence
- Audit
- Each decision carries its source, so the client's file review answers itself
Evidence cited
- Duplicate therapy dates shown against both bill pages
- Third-party liability evidence cited from the incident report
- Straight-through decisions logged against the program's own criteria
Recommended next action: Adjusters work exceptions and decisions; the program's monthly client report draws on the same record.
Frequently asked questions
What is claims automation for a TPA?
Software that performs the claim-handling work adjusters would otherwise do by hand: extracting the notice, assembling evidence, analysing coverage, reviewing demands and screening for recovery, applied per client program. The adjuster keeps the decisions and the client relationship.
Do our clients have to change systems?
No. Hesper connects to the claims system you already run through its API and works on the claims in it. Client programs keep their own rules and reporting.
How does it help in a client audit?
Every action carries its source and a timestamp, so a pulled file already contains the reasoning: what evidence was gathered, what it showed, what was recommended and who signed it. Nothing has to be reconstructed months later.
Can we start on one program?
Yes, and most do. A single program is enough to see the effect on files per adjuster and on audit results before it is applied more widely.
How is Hesper priced?
Pricing is scoped to your book: lines of business, claim volume, and which agents you deploy. Book a demo and we will walk through the economics for your programs and give you a real number.
Where to go next
Book a demo for your claims programs
A 30-minute walkthrough on one of your programs: intake, evidence, audit trail.
Book a demo