Who We Serve: TPAs

Streamline what sits between your claims system and your members.

Opyn helps TPAs modernize the high-volume interactions that drive service demand—eligibility checks, coverage questions, group onboarding, claims status and member engagement. Our platform streamlines data loads and ensures accurate information across all channels. It automates routine tasks and replaces fragmented systems with a unified, self-service experience.Your team stays focused on higher-value work.

Why TPAs Choose Opyn

Reduce demand. Lower costs. Strengthen your service.

TPAs are under pressure to deliver more with the same staff, manage rising service demand, and offer a modern experience that keeps clients loyal. Opyn gives your teams the automation and intelligence they need to do it — reducing manual work, eliminating friction, and strengthening every interaction across your ecosystem.

Reduce call-center burden
Lower OpEx
Faster resolutions at scale
Enterprise-grade stickiness
Stronger compliance alignment

Your Virtual Front Line for Provider Calls

Providers aren’t your customers—but they account for a disproportionate share of your call volume. Our AI-Powered Provider Interaction Agent handles their most common questions, instantly.

Own the Experience, AI the Navigation

Provide a unified, white-label platform that connects members, employers and brokers under your brand. Our AI assistant helps members self-navigate their health plans in real-time, reducing your administrative load by turning complex back-office workflows into seamless, automated experiences.

Compliance Turned Active Guidance

Turn Transparency in Coverage from requirement to real member guidance. Our TiC Solution interprets pricing data through AI assistance, proactively guiding members toward low-cost, high-quality providers and services.

Precision Network Navigation

Integrate your preferred networks and tier structures directly into the provider search experience. Members are guided to the right providers with less friction, reducing noise, leakage and unnecessary out-of-network claims.

Supercharge operations and CSR efficiency
‍Streamline service with a human–AI hybrid model. AI handles routine inquiries and escalates only what your team needs to review.

Lower costs for members and plans
‍Intercept high-cost events early with AI-driven navigation. Guide members to the right, in-network care or instant $0 virtual visits.

Grow your client base with best-in-class tools
‍Give clients shared access to member data and insights. Our Opyn platform enables seamless collaboration across brokers and stakeholders.

Your brand, your team, your preferred benefit solutions
‍Make the platform your own with flexible branding and group-level configuration.

Go live in weeks, not months
‍Skip long implementations. We set up your book of business and train your team—delivering fast onboarding and faster ROI.