Delivering value to our Federal and State clients through proven neutral third-party administration capabilities that drive efficiency, innovation, and scalability across complex health programs, while maintaining a steadfast commitment to supporting citizens with timely access to care, trusted service experiences, and improved outcomes.
years delivering government TPA programs
active TPA programs across Health & Human Services
customers enrolled in California TPA Programs since 2018
years of enrollment, eligibility, and premium processing experience
Proven enrollment and eligibility systems ensure Service Members, retirees, and their family members can access benefits when it matters most, keeping the force ready.
Omni-channel Digital Front Door solutions, AI-enabled contact centers, and data-driven analytics align directly with DHA's digital modernization agenda.
Deep experience as TPA prime and partner, from TRICARE to Medicaid, demonstrates Maximus' trusted role bridging government, carriers, and beneficiaries.
Centralized, neutral, accurate enrollment reconciliation across multiple carriers mirrors what DHA needs for TRICARE plan choice.
Omnichannel customer experience (CX) across phone, chat, and web, enhanced with intelligent virtual assistant support to deliver on DHA’s “anytime, anywhere” enrollment process for Service Members, retirees, and their family members.
Advanced reporting, analytics, and data integration translate TPA complexity into actionable insights, aligned with MHS GENESIS and MHS Information Platform priorities.
Centralized eligibility systems, automated determinations, qualifying life event processing, and multi-carrier enrollment reconciliation.
Payroll allotments, direct billing via credit/debit, ACH/bank withdrawals, and accurate individual-level premium reconciliation.
Phone, web chat, and email contact centers with 700K+ annual call volumes. Callbacks, escalations, and outreach campaigns.
Full provider lifecycle management, including enrollment screening, credentialing, site visits, outreach, and CMS-certified data management systems.
Comprehensive program reporting, Tableau/PowerBI dashboards, MMIS data integration, and contractor web portals for government access.
User-friendly portals with account info, plan comparison, benefits decision support, and multi-language accessibility.
Maximus supports the Office of Personnel Management by providing Open Season enrollment support for Federal Employee Health Benefit (FEHB) Program participants, serving approximately 2.7 million with over 500k annual customer contacts.
Supporting TRICARE Management Activity (TMA) System Integration Testing, coordinating integration with over 35 applications and systems, including DEERS and Dental Claims Service (DCS).
Ensuring data lifecycle management, IT infrastructure support, and operational analytics critical to ensuring accurate enrollment, eligibility reconciliation, encounter processing, and payment reporting for Uniformed Services Family Health Plan (USFHP) Program Office.
Maximus serves 13 million beneficiaries through supporting the California Health Care Options program, processing almost 3 million enrollments annually. Providing beneficiary tools and online and mobile enrollment portals, verifying eligibility status through multiple integrations with Federal and State systems.
Providing premium billing and reconciliation operations for Florida Healthy Kids, Michigan Enrolls and MiChild, Massachusetts Health Connector Enrollment and Billing. and Missouri Managed Care, processing millions of premium payments.