Employee Benefits Auditor Services

The vendor required to provide auditing and consultant firms to audit claims and operations for medical, pharmacy, dental, vision and short-term disability programs.
- The medical claims audit, the city is looking for:
•    Tests should include, but are not limited to, eligibility verification, verifying accurate plan design, provider contract terms, exclusions, and limitations such as maximum visits, prior authorization, and investigations of other party liability. 
•    The offeror may recommend additional areas as appropriate.
- The pharmacy benefit manager (PBM) claims audit, for the plan year 2025 only, the city is looking for a review of (but not limited to):
•    Dispensing fees 
•    Discounts
o    Brand
o    Generic
o    Specialty
•    Pricing assessments
•    Average wholesale price
•    Pricing accuracy
•    Aggregate discount accuracy
•    The offeror may recommend additional areas as appropriate.
- The dental audits will incorporate testing provider contracts against payments, and plan design components. 
- The vision audit should incorporate plan design components and relative fixed fee components.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: November 21, 2025