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 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 work covers coordination of benefits, subrogation, Medicare coordination, and challenging all disputed claims with providers. The administrator must also provide utilization review, large case management, wellness programs, and disease management programs. The agency requires the administrator to establish, maintain, and update Master Record files while providing instructions on proper claim submission techniques. The administrator must notify claimants and service providers of all payment decisions and report the current percentage of claims submitted electronically. Additionally, the administrator must make field claim consultants and professional services resources available to evaluate complex claims. The agency requires an annual financial accounting that includes case-specific details regarding claim reserves change items and an expense detail commentary. Eligible bidders must be onshore organizations based solely in the United States. The agency expects the performance of all work to take place offsite. The agency is looking for budget proposals to determine the cost of these services. Bidders must submit all questions regarding this opportunity no later than June 5, 2026.