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Segment and Geographic Information - Revenues and Long-lived Assets (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Revenues From External Customers And Long Lived Assets [Line Items]      
Revenues $ 1,139,231 $ 1,016,195 $ 1,047,627
TPA      
Revenues From External Customers And Long Lived Assets [Line Items]      
Revenues 1,102,032 982,492 1,005,802
Long-lived assets 208,892 216,738 200,224
U.S.      
Revenues From External Customers And Long Lived Assets [Line Items]      
Revenues 658,785 570,820 569,205
Long-lived assets 145,061 151,906 140,560
U.K.      
Revenues From External Customers And Long Lived Assets [Line Items]      
Revenues 134,663 128,674 126,337
Long-lived assets 15,923 20,290 20,749
Canada      
Revenues From External Customers And Long Lived Assets [Line Items]      
Revenues 84,945 89,162 114,438
Long-lived assets 19,579 14,404 17,999
International Countries_ Otherthan U K And Canada      
Revenues From External Customers And Long Lived Assets [Line Items]      
Revenues 223,639 193,836 195,822
Long-lived assets $ 28,329 $ 30,138 $ 20,916