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MB-2813 - USA (Brownsville, Texas) - Insurance Audit Consultant Services - Deadline February 13,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-2813

Government Authority located in Brownsville, Texas; USA based organization looking for insurance audit consultant services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide insurance audit consultant services.
-Provide on-going consulting services to assure overall plan satisfaction.
 -Review, analyse, confirm and advice regarding Self-Funded Group Health Plan, PBM, Group Life Insurance, Stop Loss, Self-funded Workers' Compensation Plan (Risk Management) and Student Athletic Insurance.
 -Review prior years data information to prepare analysis indicating trends on claims and utilization related to medical and prescription coverage in an effort to make recommendations for maximizing future health benefits while maintaining costs.
 -Monitor, analyse and review current contracts, to recommend cost effective plan designs including plan administration, compliance and claims data, performance standards, provider compliance with contracts and paid claims to ensure accuracy of coverage, terms and conditions.
 -Make funding recommendations, projections and rate structures based on an annual claims analysis, and other pertinent data.
 -Estimate renewal rates and cost trends and provide assistance in the preparation of budget forecasts and recommendations for the employee versus employer contribution rates.
 -Provide liaison and oversight services on all matters involving services provided by the TPA, representative and an agent.
 -Review and provide analysis regarding the number of claims and PPO discounts thereof. Review and provide analysis that BISD is receiving discounts as proposed by the TPA and presented in the re-pricing analysis.
 -Assist with annual health benefits, third-party administrator, stop loss renewals including price negotiations, development of bids, contracts, scope of services, distribution and analysis of qualifications, bids, or proposals received.
 -Meet / facilitate meetings with the employee benefits committee, administration, board insurance committee, and the board of trustees as requested.
 -Prepare monthly, quarterly, and annual reports relative to the health plan's expenditures, participants, services provided, claims and utilization.
 -Assist with administrative aspects of implementation of selected plans.
 -Provide research and answers to technical questions.
 -Communicate insurance market conditions and changes in legislative matters that may adversely affect both short and long term.
 -Provide the guidance, analysis and training to maintain compliance with industry changes, practices, costs and trends at the local, regional and nationals levels and the impact on the public and private sectors, including but not limited to the health insurance portability accountability act, consolidated ominibus budget reconciliation act and to provide informational materials on legislative developments impacting employee benefit management plans, including access to online reference tools on topics such as FMLA, COBRA, HIPAA, HIPAA Privacy.
(2) A contract term will be for one year.

[C] Eligibility:

Onshore (USA Only)

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Wednesday, 13 February, 2019

Category : Medical Billing and Coding

Country : USA

State : Texas

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