Helping TPAs Deliver Greater Business Value

“…With our old system, custom benefit plans used to take up to 8 hours to configure, with Quantum Choice it now takes less than 30 minutes!” –Enrollment Manager, AlwaysCare / UNUM Dental & Vision Plans

Since 1996, PLEXIS has empowered third-party administrators (TPAs) nationwide — serving clients in 37 states and supporting operations across all 50. Our Quantum Choice platform unifies benefit plan administration, auto-adjudication of claims, cost containment, and automated electronic workflows within a single, configurable system. The result: TPAs can connect their data, streamline communication, and automate operations. All while driving down administrative costs and enhancing service delivery.

The PLEXIS platform empowers TPAs to:

  • Administer diverse benefits with precision:  Manage medical, vision, dental, and group voluntary products – all within one configurable platform. Quantum Choice streamlines premium billing, commission support, and plan administration for every client group you serve.
  • Meet cost containment goals: Automate complex benefit configurations and payment calculations to boost auto-adjudication rates and prevent costly overpayments. Configurable alerts, automatic audits, and responsive analytics help TPAs identify savings and control utilization costs.
  • Connect and communicate across your ecosystem: Engage members, providers, and partners through intuitive self-service portals. Telehealth and mobile capabilities extend access to wellness tools, while online enrollment and eligibility management simplify every interaction.
  • Deliver exceptional customer service: Enhance member and client satisfaction with streamlined workflows that support call centers, customer engagement, and first-call resolution for faster, more personalized support.
  • Predict and manage costs with insight: PLEXIS Analytics (BI/BA) and predictive modeling turn operational data into actionable intelligence, empowering smarter financial and strategic decisions.
  • Scale with confidence: The PLEXIS platform is engineered to process significantly high claim volumes — while offering flexible configuration and pricing options that align with the needs of smaller TPAs and emerging organizations.
  • Simplify electronic workflows: Comprehensive EDI automation drives enterprise-wide efficiency for claims, encounter data, eligibility, and billing — ensuring speed, accuracy, and compliance across all operations.
  • Gain financial clarity: Manage multiple client accounts with dedicated checkbooks, automated reconciliation, and flexible configuration of GL accounts for tracking every revenue and payment dollar.
  • Enhance transparency for evolving compliance requirements: Meet evolving regulatory requirements with full audit visibility and secure reporting to support internal and external compliance needs.
  • Support Medicare Section 111 Reporting: The PLEXIS platform generates and imports MSP and TIN files, captures response data, and maintains all required reporting elements — including coverage type and pharmacy information — within a dedicated Section 111 reporting function.
  • Leverage intelligent automation: Agentic AI and configurable workflows help eliminate repetitive tasks and free your team to focus on strategic client service.

Configuration to meet your needs

PLEXIS delivers an integrated financial and administrative platform that gives TPAs a measurable competitive advantage. By simplifying benefit administration and automating complex workflows, PLEXIS helps reduce operating costs while empowering TPAs to provide proactive, creative benefit consulting that strengthens client relationships, optimizes customer service, and supports stop-loss carrier objectives.

For TPAs administering fully insured plans, PLEXIS streamlines risk transfer management and enables more profitable underwriting outcomes for carriers and reinsurers. With a powerful core administration and claims management engine, TPAs gain exceptional flexibility in benefit design, greater cost predictability, and a stronger position in total cost competitiveness.