The Complete Administration Cycle
From the moment a member enrolls to the final payment and reporting cycle, Globalwide manages every step of healthcare administration — so insurers, employers, and health plans can focus on their members, not their operations.
End-to-End TPA. One Partner.
Globalwide operates as a full-service third-party administrator for insurance companies, self-insured employers, health plans, associations, and international organizations. We handle the complete administration lifecycle — from policy setup and member enrollment through claims processing, provider payment, and regulatory reporting — under a single, integrated platform.
Everything Covered. Nothing Outsourced.
Our TPA platform covers the full spectrum of healthcare administration — from member onboarding to financial close.
Member Administration
Member Enrollment
End-to-end enrollment processing for individuals, families, and group schemes. We handle data intake, validation, policy assignment, and confirmation — across paper, portal, and API channels.
Eligibility Management
Real-time eligibility verification and maintenance. We manage additions, deletions, and mid-term changes — ensuring providers and members always have accurate coverage information.
Plan and Benefit Configuration
Flexible benefit plan setup supporting deductibles, co-pays, co-insurance, annual limits, sub-limits, exclusions, and waiting periods. Fully configurable per client, per scheme, per population.
Digital Membership Cards
Instant digital membership card issuance with member details, policy number, coverage tier, and emergency contact information — accessible via portal and mobile.
Claims Administration
Claims Intake
Multi-channel claims submission — direct provider billing, member reimbursement, portal upload, and EDI. Every claim is logged, acknowledged, and tracked from first receipt.
Claims Adjudication
Automated and manual adjudication against plan rules, benefit limits, exclusions, and coding standards. Consistent, auditable decisions on every claim.
Medical Review
Clinical review of complex, high-value, or flagged claims by our in-house medical team. Includes utilization review, appropriateness assessment, and second-opinion coordination.
Provider Payment
Timely, accurate payment to network and out-of-network providers. We manage remittance advice, payment reconciliation, and dispute resolution.
Reimbursement Processing
Member reimbursement for out-of-pocket expenses — validated, adjudicated, and paid directly to the member with full documentation.
Appeals and Complaints
Structured appeals and grievance management — first-level review, escalation, and resolution within defined SLAs. Full audit trail maintained throughout.
Reporting and Finance
Financial Reporting
Comprehensive financial reporting covering claims paid, outstanding liabilities, reserves, and cash flow — delivered on schedule and in client-specified formats.
Loss-Ratio Reporting
Detailed loss-ratio analysis by plan, population, benefit category, and period — giving insurers and employers the data they need to manage risk and pricing.
Employer and Insurer Reporting
Customised management information packs for employers and insurers — utilisation trends, top diagnoses, high-cost claimants, and cost-driver analysis.
Broker Commission Administration
Automated calculation and payment of broker and intermediary commissions — tracked against policy, scheme, and renewal cycle.
Renewal Support
Data-driven renewal preparation — experience reports, claims history, utilisation summaries, and rate recommendation support for underwriters and account managers.
The Complete Cycle, Step by Step
Every member journey follows a structured, auditable path — from enrollment through to final reporting.
Enrollment
Member data is received, validated, and loaded into the system. Policy assignment, benefit configuration, and digital card issuance are completed.
Eligibility
Coverage is confirmed and maintained in real time. Providers can verify eligibility instantly. Mid-term changes are processed and communicated.
Preauthorization
Planned treatments and procedures are reviewed against plan rules. Preauthorization decisions are issued to providers and members within defined SLAs.
Treatment
The member receives care. Our coordination team supports complex cases, manages direct billing arrangements, and monitors high-cost admissions.
Claim Submission
Claims are submitted by providers or members through any channel. Each claim is logged, acknowledged, and assigned for processing.
Medical and Pricing Review
Claims are reviewed for clinical appropriateness, coding accuracy, and pricing. Complex cases are escalated to our medical team.
Approval
Adjudicated claims are approved, partially approved, or declined — with full documentation of the decision rationale and benefit application.
Payment
Approved claims are paid to providers or reimbursed to members. Remittance advice is issued and payment is reconciled.
Reporting
Financial, utilisation, and management reports are generated and delivered to insurers, employers, and brokers on agreed schedules.
Enrollment
Member data is received, validated, and loaded into the system. Policy assignment, benefit configuration, and digital card issuance are completed.
Eligibility
Coverage is confirmed and maintained in real time. Providers can verify eligibility instantly. Mid-term changes are processed and communicated.
Preauthorization
Planned treatments and procedures are reviewed against plan rules. Preauthorization decisions are issued to providers and members within defined SLAs.
Treatment
The member receives care. Our coordination team supports complex cases, manages direct billing arrangements, and monitors high-cost admissions.
Claim Submission
Claims are submitted by providers or members through any channel. Each claim is logged, acknowledged, and assigned for processing.
Medical and Pricing Review
Claims are reviewed for clinical appropriateness, coding accuracy, and pricing. Complex cases are escalated to our medical team.
Approval
Adjudicated claims are approved, partially approved, or declined — with full documentation of the decision rationale and benefit application.
Payment
Approved claims are paid to providers or reimbursed to members. Remittance advice is issued and payment is reconciled.
Reporting
Financial, utilisation, and management reports are generated and delivered to insurers, employers, and brokers on agreed schedules.
Built for Complexity. Designed for Scale.
Configurable for Any Scheme
Our platform supports any benefit structure — from simple group health plans to complex multi-tier, multi-currency international schemes.
Fully Auditable
Every decision, every payment, every communication is logged and traceable. Our clients have complete visibility at all times.
Multilingual Operations
Our teams operate in multiple languages across multiple time zones — supporting members and providers wherever they are.
Integrated Medical Expertise
Unlike pure administrative TPAs, our in-house medical team is embedded in the claims process — adding clinical rigour to every complex case.
Ready to Outsource Your Administration?
Talk to our team about how Globalwide can take on your TPA operations — from a single scheme to a full portfolio.
Request a Proposal