Insurance Consulting and Analytics Firm Services

The Vendor is required to provide insurance consulting services, as needed, during the period beginning august 2026 and ending July 2027.
- Requirement:
• Provide ongoing consulting services to assure overall plan satisfaction.
• Review, analyze, 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 an analysis indicating trends on claims and utilization related to medical and prescription coverage in an effort to make recommendations to the district for maximizing future health benefits while maintaining costs.
• Monitor, analyze, 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 to the district in the preparation of budget forecasts and recommendations for the district’s employee versus employer contribution rates.
• Liaison and oversight services on all matters involving services provided by the TPA, representative, and agent.
• Review and provide analysis regarding the number of claims and PPO discounts thereof.
• Review and provide analysis that agency 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 and 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 the administrative aspects of the implementation of selected plans.
• Research and answers to technical questions asked by the district.
• Communicate insurance market conditions and changes in legislative matters that may adversely affect the district, both short-term and long-term.
• District guidance, analysis, and training to maintain compliance with industry changes, practices, costs, and trends at the local, regional, and national levels and the impact on the public and private sectors, including but not limited to the health insurance portability and accountability act (HIPAA), consolidated omnibus budget reconciliation act (cobra) 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.
• Research, review, and resolve issues concerning insurance policies, certificates of insurance, disputes regarding coverage, billing questions, service delivery, and other documents relating to employee benefits and or other insurance products.
• Assist in drafting employee communications regarding benefit program performance and changes, and assist in the review of plan documents and insurance certificates during the planning and enrollment process.
• Research and determine the feasibility and need of agent services.