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53. Is Your TPA Costing You More Than You Think?

53. Is Your TPA Costing You More Than You Think?

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 In this no-nonsense episode of The Business of Benefits, host Chelsea Ryckis dives into the critical but often misunderstood world of Third Party Administrators (TPAs) with industry veteran Eugene Starks. This episode offers employers and consultants a candid breakdown of why the TPA is arguably the most important player in a health plan—acting as the “quarterback” responsible for claims processing, eligibility management, vendor coordination, and plan integrity.

Eugene brings over two decades of insider expertise to the table, explaining:
  • The core functions of a TPA—including paying claims, managing eligibility, and building plan logic
  • What questions employers should ask when selecting a TPA (e.g., claim turnaround time, fee transparency, ownership structure, and scalability)
  • Red flags to look for in TPA contracts—like hidden fees, clawback charges, or outsourced claim processing
  • How TPAs interact with other key components like PBMs, stop-loss providers, and networks
  • The importance of employee communication and education in plan success, especially when using point solutions or reference-based pricing
They also tackle a hot debate: should the consultant or the TPA be the “true quarterback”? The takeaway—collaboration is key. Success lies in choosing the right consultant who partners effectively with the right TPA, ensuring strategic alignment, smart cost-containment, and a great member experience.

Don’t be distracted by lower admin fees—value, transparency, and execution matter more. If you're ready to rethink how benefits should actually work, this episode is your playbook.

Connect with Chelsea and Donovan:
Website: www.ethoseffectpodcast.com
Instagram: https://www.instagram.com/ethoseffectpodcast/
Chelsea: https://www.linkedin.com/in/chelsea-ryckis
Donovan: https://www.linkedin.com/in/donovanryckis/
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