Health Insurance Claims Administration

This subcontract for Health Insurance Claims Administration supports prime contractors managing medical claims for Virginia Commonwealth University student health insurance projects. The scope of work involves the administrative processing and disposition of paid, clean, and suspense claims, as well as the management of external reviews, grievances, and appeals. Additionally, the provider is responsible for executing coordination of benefits and subrogation tasks using HIPAA-compliant adjudication software. The selected provider must ensure strict adherence to HIPAA and ACA parity compliance while delivering performance reports, determination letters, and adjudicated claims. This opportunity falls under NAICS code 541611, with a response deadline set for November 18, 2026.