City of Jersey City

Buyer is requesting proposals from Third Party Administrators for claims administration, claims management services, and provider network services for its medical health plans for employees and retirees. The current plans are administered by Horizon Blue Cross and Blue Shield of New Jersey. The plan covers 5,004 subscribers including 2,592 active employees and 2,412 retirees. The contract will be awarded for a three-year term beginning January 1, 2026.

• 5/9/2025 - Issuance of Request for Proposals
• 6/12/2025 - Proposal Due Date
• 1/1/2026 - Contract Start Date

• Five consecutive years experience with New Jersey Public Entities
• Process claims for at least three government agencies in NJ
• Experience with at least 3,000 covered lives
• Maintain compliance with New Jersey healthcare regulations

• Provide claims administration and claims management services
• Offer provider network services for medical health plans
• Process and manage claims for employees and retirees
• Implement utilization review and health information line
• Provide case management and precertification services
• Ensure HIPAA compliance
• Manage disease management and predictive modeling
• Handle stop loss claim filing and accounting
• Provide network access and provider management
• Submit detailed monthly utilization and claims reports