BPO Service
Insurance claims outsourcing for carriers, MGAs and TPAs
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Direct answer
Insurance claims outsourcing gives adjusters external help with claim administration. Actigy BPO runs first notice of loss (FNOL) intake, data entry, document indexing and adjudication support from Bulgaria, Romania, Poland and Ukraine. The team prepares decision-ready files. Your licensed staff keep coverage, reserves, settlement and payment authority.
Describe your workflow, volume and required coverage. You decide on a pilot after reviewing the written scope.
Defined data-access controls · You own the procedures · Pilot before you scale
Claims scope: the team prepares and routes a complete claim file, but coverage, liability, reserves, settlement and payment authority stay with the insurer.
Claims processing results: 4.2-minute intake (Actigy BPO-reported)
- The team cut claims intake turnaround from 42.5 to 4.2 minutes.
- The team reports that claims leakage fell from 5.8% to 0.3% of volume.
Results come from anonymized client engagements, are reported by Actigy BPO and are not independently audited. Results depend on scope. Property and casualty (P&C) claims case: 4.2-minute intake
At a glance
Insurance claims outsourcing at a glance
Actigy BPO is a nearshore business process outsourcing (BPO) company headquartered in Prague, Czech Republic. Claims operators handle administration under your standard operating procedures (SOPs). Adjusters keep decisions. The process audit defines file types, systems, access and review rules before the team starts a paid pilot.
| Service | Insurance claims processing support, from intake to instructed file closure |
|---|---|
| Who it serves | Insurers, managing general agents (MGAs), third-party administrators (TPAs) and brokers |
| Delivery | Bulgaria, Romania, Poland and Ukraine, in client-approved systems |
| Coverage | Full UK business day and US morning; additional shifts agreed in writing |
| Pricing | Monthly rate per full-time equivalent (FTE), by role; written quote after the audit |
| Start | Process audit, paid pilot and a client-approved scale decision |
Key takeaways
- Every Actigy BPO engagement starts with a process audit and a paid pilot.
- Actigy BPO handles administrative claims work; the client keeps claims approval and payout authority.
- Test incomplete files and urgent exceptions before adding volume.
- Compare file completeness and rework, not only the price per operator.
How Actigy BPO supports the claims lifecycle
Claims operators collect information, prepare files and send approved updates. Actigy BPO works in the client's tools, with access limited to the systems the client approves. A written checklist defines each handoff. Coverage, liability, reserves, settlement and payment decisions stay with the insurer and its authorized staff.
| Stage | Operator task | Client authority |
|---|---|---|
| Intake and triage | Record first notice of loss, contacts and the policy reference. Route urgent files. | Set intake rules and confirm coverage. |
| Data and documents | Validate fields, index documents and request missing evidence. | Resolve policy questions and approve nonstandard requests. |
| File preparation | Check completeness, flag inconsistencies and record open questions. | Decide liability, reserves, investigation and settlement. |
| Status and payment preparation | Record approved status and prepare payment information. | Approve and release payment. |
| Recovery and closure | Flag possible subrogation, assemble records and follow approved closure instructions. | Authorize recovery, closure or reopening. |
When can you outsource insurance claims data entry?
Actigy BPO supports claims data entry when field rules, required documents and exception owners are clear. Operators compare entries with the source record. Missing policy details, duplicate documents and inconsistent dates go to the named reviewer. Neither complete data nor a low-severity label gives an operator permission to decide a claim.
High-volume queues can include property, auto physical damage, workers' compensation medical-only or general liability administration. These are scoping options, not claims of delivery history. The audit confirms the eligible claim types and authority limits for your system.
How Actigy BPO scales claims capacity for surges
Actigy BPO reviews the claims backlog before proposing more staff. The team needs the file count, required skills and available review time. The written plan sets out hiring or training, system access, quality checks and how staffing will grow and later reduce. Confirm who is available before agreeing a start date.
| Pressure | Plan before adding volume | Release condition |
|---|---|---|
| Seasonal backlog | Forecast arrivals, backlog age and daily reviewer capacity. | Approved staffing and priority order |
| Catastrophe event | Separate new intake from urgent exceptions and existing files. | Trained operators and an available client escalation owner |
| New program | Test rules and sample files before transferring the queue. | Pilot quality thresholds met |
| Volume falls | Agree notice, staffing changes and unfinished-file transfer. | Documented handover and access removal |
Additional operators do not remove an adjuster bottleneck. Track files awaiting a client decision separately from processing work. Cross-training is a planning option, not a promise of an idle reserve team.
How do you keep claims data accurate?
Actigy BPO uses a second operator to check claims work against the approved rules. This is the maker-checker step in quality assurance (QA). The team also samples work and records errors and their causes. Monthly reviews show which delays come from missing evidence, client decisions or changed claims rules.
- Intake cycle time: elapsed time from receipt to the agreed processing handoff.
- Touch time: time an operator spends working on the file.
- Backlog age: time since a file entered the queue, grouped by reason.
- Data accuracy: reviewed fields that match the source and validation rules.
- Rework: files returned for a processing correction.
- Service-level agreement (SLA) attainment: work completed within the agreed service threshold.
Agree definitions, denominators and review samples before the pilot. A low average processing time can hide old exceptions. Report missing evidence and client-held files separately, with an owner for each next action.
How does an insurance claims pilot start?
Actigy BPO starts with a process audit and a paid pilot on real workflow conditions. A pilot usually starts 2 to 4 weeks after the audit. Timing depends on access, training and client approval. The client approves more volume only after the pilot meets the thresholds written in the SOP.
- Audit: map file types, systems, decisions, queues and access restrictions.
- Prepare: approve checklists, scripts, QA samples and escalation contacts.
- Pilot: test complete files alongside missing policy data, duplicates, possible fraud and deadline risks.
- Review: compare completeness, accuracy, routing and processing time with the agreed thresholds.
- Scale: approve the next queue or volume only after review.
See how the process audit and paid pilot work. The team records client-held decisions so their waiting time does not distort operator performance.
Insurance claims outsourcing in Europe: what protects records?
Actigy BPO limits access to the systems and records the client approves. Roles, logging, retention and transfer terms form part of the written scope. Bulgaria, Romania and Poland are EU locations; Ukraine is outside the EU. Confirm permitted locations before giving a team access to claim records.
ISO 9001-aligned quality management. Aligned, not certified. SOC 2-aligned controls: role-based access, logging and segregation of duties. Aligned, not audited.
The client and provider agree GDPR-related data processing and transfer terms for the engagement. No location or alignment statement replaces a review of your contracts. Operators escalate suspected fraud, complaints and policy questions; they do not resolve them through unapproved automation.
How do claims processing outsourcing companies differ?
Actigy BPO manages the agreed claims administration work. When comparing providers, check who leads the team, reviews the work and makes decisions. You manage in-house staff yourself. With a contractor or staffing agency, you usually keep that role too. Check each proposed contract for duties and liability.
| Question | Actigy BPO managed team | In-house team | Individual or staffing agency |
|---|---|---|---|
| Daily work | Provider team lead | Your manager | Usually your manager |
| SOP ownership | Client-owned | Client-owned | Confirm ownership in the contract |
| Quality checks | Agreed maker-checker QA | Your review process | Your review unless separately contracted |
| Coverage | Written shift scope | Employee schedules | Individual availability |
| Start | Audit and paid pilot | Hiring and training | Selection, access and training |
| Pricing | Per FTE by role | Salary and employment costs | Contract rate and any agency fees |
| Exit | Current SOPs and agreed handover | Internal knowledge transfer | Contract-dependent handover |
When does managed claims support fit?
Actigy BPO fits when adjusters need administrative capacity for repeatable queues, document collection or seasonal backlogs. A named client owner must approve rules and handle exceptions. Actigy BPO is not the right fit when you need settlement authority, on-site inspections or claims software instead of an operations team.
What determines the price?
The quote names operator, review and leadership roles. Claim volume, document complexity, exception rates and coverage determine staffing. Ask which training, transition and surge costs the quote includes. Use the cost per FTE resource to compare assumptions, not as a supplier quote.
You retain the SOPs, checklists and exception records. Exit terms define documentation transfer, unfinished files, access removal and knowledge transfer. Keep adjuster availability and contractual decision duties separate from the processing fee.
Claims backlog and FNOL support for US insurers
Actigy BPO fits insurers, managing general agents and claims administrators that need a managed owner for claims intake and documentation. The team prepares complete, traceable files for your adjusters. It does not replace licensed claims decisions, set reserves, decide coverage or release settlements.
Claims intake rises after a surge
For an acquisition, new program or seasonal spike, split incoming first notice of loss (FNOL) from the existing backlog. Agree staffing, intake fields and urgent handoffs before launch. Catastrophe work needs its own readiness and coverage plan; the service is not an instant emergency-response promise.
Adjusters spend too much time on administration
Actigy BPO can run agreed indexing, data checks, missing-document follow-up and status updates in your claims system. Use a file-completeness checklist and second review. Track intake age, missing evidence and work returned by adjusters instead of treating faster intake as faster claim settlement.
Compare insurance BPO companies by operating scope. A US-only workforce requirement needs domestic delivery; European access and out-of-hours shifts must be explicitly acceptable to the buyer.
FAQ
Insurance claims outsourcing questions
What is insurance claims outsourcing?
Insurance claims outsourcing assigns claims administration to an external team. Actigy BPO provides intake, data entry, indexing, file checks and approved status updates. The insurer retains coverage, liability, reserves, settlement and payment decisions. A written scope defines the records operators can access and the exceptions they must escalate. Start with a defined queue so you can test file quality before adding volume.
Which claims tasks can be outsourced, and which stay with adjusters?
Actigy BPO handles agreed administrative tasks; adjusters retain claims decisions. Operators can collect documents, check fields, prepare evidence and send authorized updates. They flag missing information rather than make a policy judgment. The insurer decides coverage, liability, reserves, settlement and payment. Record these boundaries in the SOP, with a named reviewer for suspected fraud, complaints and deadlines that need a client decision.
Is claims processing outsourcing the same as hiring a TPA?
No. Claims file support does not include the wider duties or authority of a third-party administrator. Actigy BPO can support an insurer's or TPA's administrative queue.
The client sets decision limits, supervision and licensing requirements. Compare the written scope rather than the label. Preparing a claim file does not give a provider authority to settle or pay it. Ask who can sign off each step before work starts.
Can an outsourced team handle first notice of loss (FNOL)?
Actigy BPO can handle FNOL intake within approved scripts and access rules. Operators record the loss, contact details and policy reference. They check required fields and route urgent or incomplete records.
Insurance call center outsourcing covers the contact queue. Intake does not confirm coverage or promise payment. Agree channels, opening hours and escalation contacts in writing. The pilot tests incomplete records and urgent exceptions as well as straightforward reports of loss.
How do you keep claims data accurate?
Actigy BPO uses documented field checks, maker-checker review and QA sampling against the client's rules. Operators record defects and return unclear source information to the named owner. The review distinguishes data-entry errors from missing documents or unresolved policy questions. Agree the sample, accuracy definition and escalation threshold before the pilot. Review recurring errors each month and update the approved procedure when a rule changes.
How fast can a claims processing team start?
A pilot with Actigy BPO usually starts 2 to 4 weeks after the process audit. Timing depends on access, training and client approval, not only operator availability. Before live work, approve the file checklist, data locations, authority limits and escalation contacts. A new or undocumented workflow needs preparation first. The written proposal confirms the start date, pilot queue and conditions for adding more volume.
Does Actigy BPO support UK claims handling?
Actigy BPO provides administrative claims support with full UK business-day coverage. The team does not take over licensed claims decisions. The written scope confirms staffing locations, permitted data access, channels and escalation times. UK claims handling outsourcing also needs an available client decision-maker for urgent exceptions. Compare nearshore and offshore BPO by actual shifts and data arrangements, not geography alone.
How is claims outsourcing priced?
Actigy BPO quotes a monthly rate per FTE by role after the process audit. The staffing plan depends on file volume, complexity, review needs and coverage. Ask for the operator and leadership roles, training assumptions and surge terms in writing. Compare equivalent queues and review coverage across proposals. A low headline rate does not show the total cost if your own team still performs repeated rework.
How does Actigy BPO handle catastrophe or seasonal claim surges?
Actigy BPO plans surge capacity against the forecast, training needs and available client review capacity. The proposal defines any additional operators, shifts, notice and ramp-down terms. Availability requires confirmation for each engagement. Split new intake, existing backlog and urgent exceptions into separate queues. Keep a client escalation owner available so additional processing capacity does not leave decision-ready files waiting without action.
What does a claims analyst do?
A claims analyst reviews claim information, checks records and identifies issues for the responsible decision-maker. Actigy BPO claims operators perform only the administrative tasks in the written scope. A job title does not grant authority to approve coverage or release payment. Buyers need to confirm the actual workflow, access and supervision. This service page describes outsourced operations, not a vacancy or a promise of licensed adjusting services.
Outsource the process. Keep control of the outcome.
Describe the claims workflow you want to outsource. The team will assess scope, complexity, staffing and delivery cost.
Describe your workflow, volume and required coverage. You decide on a pilot after reviewing the written scope.
Scope a pilot
What happens next
The team reviews the workflow before proposing a written scope. You decide whether to start a paid pilot after reviewing it.