Third party administrators need claims software that runs several clients' claims to contract, and leaves a clear record for each insurer. ClaimsGateway (claimsgateway.com), Five Sigma, Wilbur and VCA Software all sell claims platforms to TPAs. They differ most in Australian presence, who changes workflows and the lines of business they cover.
Key takeaways
- Under the General Insurance Code of Practice, a TPA contracted to manage claims for an insurer counts as one of its Service Suppliers.
- According to the Code Governance Committee, claims caused 59% of the 70,325 Code breaches recorded in 2024-25.
- According to APRA, CPS 230 has applied since 1 July 2025, and it requires insurers to manage their material service providers.
- A TPA's claims software is judged by its insurer clients as much as by the TPA, because every breach lands on the insurer's record.
What does a TPA need from claims software?
A third party administrator manages claims for several clients, each with its own rules, limits and reporting. So its software has to run each client's process faithfully, keep each client's data and decisions clearly separated, and produce a record any client can audit. Efficiency matters, but accountability to the client decides contracts.
That makes TPA claims work different from an insurer's. An insurer answers to its regulator and its customers. A TPA, however, answers to them through its clients, which are often insurers and underwriting agencies. The what a TPA is sets out the different TPA models in Australia.
The scope here is property and casualty claims, including injury and workers' compensation where a TPA handles them for insurers. Health insurance TPA systems are a separate market and are left out.
How were these options assessed?
Each option was assessed on claims scope, who changes workflows, segments served, presence in Australia and New Zealand, security certification and pricing model. For a TPA, two points weigh most: whether the platform can run several clients' processes, and what security certification a client's due diligence will find.
Multi-client operation and service level tracking were judged only by what each vendor publishes, because no independent test exists. Every vendor fact was checked on the vendor's own site, or a dated news source where noted, in October 2026. The ClaimsGateway TPA page shows how one platform approaches TPA work.
Which claims platforms suit TPAs?
Four claims platforms sold to TPAs are compared here. ClaimsGateway, Five Sigma and Wilbur are cloud claims platforms selling into Australia, and Five Sigma has a named Australian TPA customer. VCA Software is a long-standing claims platform for TPAs and adjusting firms in North America and the Lloyd's market.
1. ClaimsGateway
Best for: TPAs handling several classes of claim that want workflows they can configure themselves, with payments built in.
Typical customer size / segment: From small brokers to large enterprises, as its own site positions it, with a dedicated page for TPAs.
Key strengths:
- Workflows are configured without developers, so the TPA owns changes to its processes.
- It covers property, motor, liability, construction, injury and workers' compensation claims, from first notice of loss to close.
- Payments are built in, with automated set-up and tracking, reconciliation, fraud detection and AML sanctions checks.
Claims scope: The whole product.
Who changes workflows: The business, without developers.
Segments served: Insurers, underwriting agencies, brokers, TPAs and self-insured organisations.
Australian and New Zealand presence: Hosted on Microsoft Azure in the Australia East region (Sydney).
Security certification: ISO/IEC 27001.
Watch-outs: A very small TPA with one claims handler and low volumes may find a well-kept spreadsheet is still enough.
Pricing: Volume-based, set by annual claim volume, with unlimited users. Its pricing page listed plans from AUD 5,500 a year ex GST in October 2026. An implementation fee and a minimum 3-year term apply.
2. Five Sigma
Best for: TPAs that want AI built into claims handling, with Clive working on its own platform or on top of an existing system.
Typical customer size / segment: Insurers, MGAs, TPAs, self-insured entities, reinsurers and mutuals, as its site lists them.
Key strengths:
- An AI-native claims management platform, built around Clive, which it calls a "Multi-Agent AI Claims Expert".
- Chosen in May 2026 by Quartz Claims, an Australian TPA, as "the core infrastructure for its claims operation" (Coverager).
- According to Coverager, it surfaces recommendations according to insurer-specific procedures, which suits a TPA working to several clients' rules.
Claims scope: The whole product.
Who changes workflows: Not stated on the pages reviewed.
Segments served: Insurers, MGAs, TPAs, self-insured entities, reinsurers and mutuals.
Australian and New Zealand presence: One named Australian TPA customer, Quartz Claims. No local office is stated on its site.
Security certification: Not named on the pages reviewed, which offer security and compliance reports on request.
Watch-outs: Its site does not state where support is based, so TPAs should confirm support hours and data residency for their clients.
Pricing: Not published.
3. Wilbur
Best for: TPAs that want a cloud claims platform with AI and analytics modules, sold to TPAs as a named segment.
Typical customer size / segment: Insurers, managing general agents, brokers and TPAs, according to Insurance Business (September 2024).
Key strengths:
- A real-time claims management platform developed by Claim Central Consolidated.
- AI and analytics modules launched in September 2024, aimed at claims efficiency and fraud.
- TPAs are one of the four segments it names.
Claims scope: The whole product.
Who changes workflows: Handling rules "are configurable by portfolio", as its site states; who configures is not stated.
Segments served: Insurers, MGAs, brokers and TPAs.
Australian and New Zealand presence: Its 2024 launch included an Australian roadshow, according to Insurance Business.
Security certification: Not stated on its homepage.
Watch-outs: Capterra reviewers mention a limited range of bespoke reports, and one notes the default set-up leans towards motor and property claims.
Pricing: Not published.
4. VCA Software
Best for: TPAs and adjusting firms working North American or Lloyd's market business across property and casualty lines.
Typical customer size / segment: TPAs, adjusting firms and carriers. VCA reports "150+ client organizations, four regions and the Lloyd's market" (vcasoftware.com, October 2026).
Key strengths:
- "Claims management software for property and casualty insurance", covering personal and commercial lines, casualty, property and specialty.
- More than 20 years building claims software, as its site states.
- Experience with the Lloyd's market, served "for more than a decade".
Claims scope: The whole product.
Who changes workflows: Not stated on the homepage.
Segments served: TPAs, adjusting firms and carriers.
Australian and New Zealand presence: None stated. Its listed offices are in Scottsdale, Arizona and Bolton, Ontario.
Security certification: SOC 1 and SOC 2 Type 1 and Type 2, as its site states.
Watch-outs: Workers' compensation and health benefits are outside its scope, by its own description, and it states no Australian presence.
Pricing: Not published on the homepage.
Why is compliance exposure the TPA buying trigger?
For a TPA, a compliance failure is a client failure. Under the General Insurance Code of Practice, a party contracted to manage claims for an insurer is one of its Service Suppliers. As a result, a TPA's missed deadline or unrecorded decision becomes a breach on the insurer's record.
The numbers explain why insurers are looking harder. According to the Code Governance Committee, Code breaches rose 20.5% to 70,325 in 2024-25, and 59% of them related to claims. Missed 20 business day progress updates alone accounted for 18,350 breaches, up 67% on the year before. The Code also requires a Service Supplier to tell the insurer within two business days about any breach it becomes aware of.
APRA adds a second layer. According to APRA, CPS 230 commenced on 1 July 2025 and requires insurers to manage arrangements with material service providers. A TPA that runs an insurer's claims is often one. So the insurer's due diligence now asks about operational resilience, security and records, not only service levels. The CPS 230 explainer covers what that means in practice.
How should a TPA shortlist claims software?
A TPA should shortlist on three things: whether the platform can run each client's rules without custom development, whether its security certification will pass a client's due diligence, and whether its record of every decision would satisfy an insurer's audit. Features matter less than those three.
First, test configuration with a real client's rules. Ask the vendor to set up two clients with different referral limits and update cycles, and watch who does the work. Second, ask for the certification a client will ask for, usually ISO/IEC 27001 or SOC 2, and where the data is hosted. Third, pick a finished claim and ask the vendor to show every decision, who made it and when.
The choosing TPA claims software goes through each test in more detail.
For TPAs weighing whether clients should buy software or outsource, the software versus outsourcing comparison covers the client's side of that decision.
Frequently asked questions
What is TPA claims software?
TPA claims software is a claims management system built for third party administrators, who handle claims on behalf of insurers, agencies or self-insured organisations. It runs each client's claims process, tracks every decision and payment, and keeps a record each client can audit. It differs from insurer software mainly in serving several clients at once.
Can one claims platform serve several TPA clients?
Yes, many claims platforms are sold to TPAs on that basis, though how they separate clients varies. A TPA should test how a platform handles different rules, limits and reporting for each client, who sets them up, and how one client's data is kept apart from another's before signing any contract.
What security certification should a TPA claims system have?
Most insurer clients expect ISO/IEC 27001 or a SOC 2 report from the systems that hold their claims data, and they will ask where that data is hosted. ClaimsGateway, for example, is ISO/IEC 27001 certified and hosted in Sydney, while VCA Software reports SOC 1 and SOC 2 certification.
Do TPAs fall under APRA CPS 230?
Not directly, because CPS 230 applies to APRA-regulated entities such as insurers. However, a TPA that manages an insurer's claims is often one of that insurer's material service providers. So the insurer must manage the arrangement under CPS 230, and it will pass its expectations on to the TPA through the contract.
What claims software do Australian TPAs use?
Australian TPAs use a range of claims systems, and few publish which one they run. For example, Quartz Claims, an Australian TPA, chose Five Sigma in May 2026. Other platforms selling to TPAs include ClaimsGateway, Wilbur and VCA Software, though VCA states no Australian presence. The right choice depends on the TPA's clients and lines.
About the author
ClaimsGateway builds cloud claims management software for insurers, underwriting agencies, brokers, TPAs and self-insured organisations in Australia and New Zealand. Every regulator figure in this article links to its source, and every vendor fact was checked on the vendor's own site on the date shown.
Related reading
- Claims administration software: a wider list for claims administration work.
- Claims software in Australia: the full market, grouped by type of system.
- The Code of Practice explained: the claims obligations a TPA works to.
Sources
- Insurance Council of Australia. General Insurance Code of Practice (2020 Code, as amended), Part 5 and the definition of Service Supplier. https://insurancecouncil.com.au/code-of-practice
- Insurance Business Australia. "Record AFCA complaints mask a worse story in insurer compliance data." 4 August 2026. https://www.insurancebusinessmag.com/au/news/breaking-news/record-afca-complaints-mask-a-worse-story-in-insurer-compliance-data-584812.aspx (reports the Code Governance Committee's 2024-25 data)
- APRA. "Operational risk management (CPS 230)." Checked 16 October 2026. https://www.apra.gov.au/operational-risk-management
- Coverager. "Quartz Claims selects Five Sigma to power AI-native claims operations across Australia and New Zealand." 6 May 2026. https://coverager.com/quartz-claims-selects-five-sigma-to-power-ai-native-claims-operations-across-australia-and-new-zealand/
- Insurance Business Australia. "Wilbur unveils AI and analytics tools for insurance industry." 3 September 2024. https://insurancebusinessmag.com/au/news/technology/wilbur-unveils-ai-and-analytics-tools-for-insurance-industry-503854.aspx
- Vendor websites, each checked 16 October 2026: fivesigmalabs.com, vcasoftware.com, claimsgateway.com.
- Wilbur, wilbur.io, and its Capterra reviews (search results only), checked 21 October 2026. https://wilbur.io
