Third Party Administrator Services for Medical

The Vendor is required to provide for third party administration of medical benefits.
- Initiate and conduct all necessary and timely investigation of all claims and/or invoices for which reports are furnished by agency personnel.
- Provider will be responsible for informing agency staff of all newly introduced regulations/laws and modification to existing regulations/laws with the intent being to maintain compliance with regulations and to benefit financially from government directed programs.
- Shall issue appropriate instrument(s) to effect and satisfy claim settlement in a timely manner.
- Responsible for answering all inquiries from claimants and assume responsibility for the adjustment of all claims so that these activities are diverted from agency personnel.
- Provide COBRA administration for all current and future enrollees/employees, including members in their fully insured plan.
- Network and Administration Capabilities
• Depth and quality of the provider network including regional and national coverage
• Ability to support existing medical plan designs
• Clinical management programs
• Auditing, monitoring, reporting, and quality assurance practices to ensure ongoing compliance and operational accuracy.
- Organizational Capacity and Experience
• Company experience and demonstrated expertise in the administration of medical plans, Flexible Spending Accounts (FSA) and COBRA continuation coverage, including compliance with applicable federal and state regulations.
• Availability of qualified staff, documented administrative procedures, internal controls, and client references.
• Specific qualifications, training, certifications, and experience of the personnel assigned to the account.
- Customer Service
• Availability, accessibility, and responsiveness of customer service for members.
• Service standards and performance metrics to ensure accuracy, timeliness, and customer satisfaction.
• Member education, communication materials and self-service resources related to all programs.
• Timeliness and accuracy of eligibility administration, claim processing and notification processes