Stop-Loss Claims Administration

This subcontract for Stop-Loss Claims Administration involves providing administrative processing for prime insurance carriers supporting Illinois State Toll Highway Authority employee benefits projects. The selected provider will be responsible for reviewing medical claims against established thresholds, validating member eligibility, and calculating reimbursement amounts. All operations must be conducted using claims management software and data handling systems that adhere to strict HIPAA compliance standards. The contract requires the provider to maintain HIPAA Compliance certification and Professional Liability Insurance to ensure data security and operational risk management. Key deliverables include the submission of processed claim reports and the execution of reimbursement disbursements. The work is associated with NAICS code 524291 and is centered in Downers Grove, Illinois.