The vendor is required to provide data warehouse and analytics tool to the county for their self-insured medical, dental, and Rx plans.
a. Data storage, security, and management:
• Centralized data storage: collect and store comprehensive insurance-related data, including claims, premiums, actuarial reports, and policy details, in a structured and accessible manner.
• Enhanced risk analysis: utilize historical data to identify trends, predict risks, and refine underwriting processes for better coverage decisions.
• Improved claims management: track claim histories, detect patterns in fraudulent activities, and optimize claim processing efficiency.
• Regulatory compliance and reporting: ensure accurate and timely reporting for regulatory requirements, audits, and stakeholder transparency.
• Cost control and financial insights: monitor expenses, forecast liabilities, and assess funding adequacy to maintain financial stability.
• Integration with other systems: enable seamless data flow with plan administrator, consultants, HR, and other enterprise systems to support cross-functional decision-making.
• Data security and privacy: safeguard sensitive information through robust access controls and encryption to comply with legal and ethical standards.
• Users will have no access to act protected information, all data will be de-identified and inaccessible to users.
b. Continuous improvement, auditing, and optimization
• AI and machine learning integration: incorporate predictive analytics for more advanced risk forecasting and claims cost optimization.
• Drill down capabilities that maintain privacy to the individual.
• Data warehouse scalability: plan for future growth by ensuring the system can handle increasing data volumes and complexity.
• County’s ability to own all claims data.
• Automated auditing tools: build tools that continuously monitor data quality, compliance, and reporting accuracy.
c. User experience and stakeholder engagement
• Customization for different users: develop role-specific dashboards for finance, risk management, and actuaries.
• Mobile access and remote capabilities: ensure stakeholders can securely access reports and insights from anywhere.
• Collaboration features: implement data-sharing protocols and reporting templates for interdepartmental coordination.
d. Governance and compliance enhancements
• Data lifecycle management: define retention policies and archival strategies to ensure efficient historical tracking.
• Advanced security protocols: implement multi-factor authentication, real-time threat detection, and compliance tracking to prevent breaches.
• Legal and ethical considerations: ensure alignment with regulations beyond standard insurance laws, such as data privacy mandates.
- Contract Period/Term: 1 year
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