Third Party Claims Administrator Services

The agency is seeking a qualified vendor to provide comprehensive third party claims administrator services. The agency needs to solve the challenge of transitioning and managing its claims administration processes seamlessly without interruption to services. The selected administrator must complete all enrollment and eligibility tasks prior to the contract effective date through electronic data transfers from the current third-party administrators. The scope of work requires the administrator to manage and process all claims starting on the effective date of the contract. This management includes coordinating benefits, handling subrogation, coordinating with Medicare, and challenging all disputed claims with providers. The agency also requires the administrator to provide utilization review, large case management, wellness programs, disease management programs, and instructions on proper claim submission techniques. The administrator must establish, maintain, and update master record files while tracking the percentage of claims submitted electronically. The agency requires the administrator to notify claimants and service providers of all payment decisions and to provide field claim consultants and professional resources for complex claim evaluations. Additionally, the administrator must deliver an annual financial accounting that includes case-specific details on claim reserves, change items, and detailed expense commentaries. Eligibility is strictly limited to onshore organizations based in the United States. The agency requires all performance of the work to occur offsite. The agency has not disclosed a set budget and is looking for proposals to define the cost structure. Bidders must submit all questions regarding this opportunity no later than June 5, 2026.