Benefits Broker and Consulting Services

The Vendor is required to provide benefits broker and consulting services for employee benefits broker, consultant, and strategic advisor.
- Requirement:
1. Strategy and plan design
• Multi-year benefits strategy and cost projection with measurable annual goals
• Analyze utilization, experience, and benchmarking data; recommend plan-design improvements, provide experience with analysis and capabilities with cost
• Advise on funding strategy with actuarial/underwriting support
• Model financial and employee-impact of recommended changes before implementation
• Present to leadership or governing boards as requested
• Experience with dual options for medical benefit design
2. Marketing and negotiation
• Conduct competitive market analysis and carrier for lines of coverage as directed
• Evaluate proposals and present clear, comparable analysis
• Negotiate rates, terms, performance guarantees, and contract language on the organization's behalf
3. Cost management and population health
• Recommend and implement pharmacy cost management strategies; advise on PBM contracting, list successful initiatives
• Advise on wellbeing, behavioral health, and condition-management programs with measurable outcomes
• Successful wellness initiatives
• Monitor stop-loss or other risk coverage; track large-claim exposure; provide examples of measurable outcome
• Identify and coordinate with employees who suffer from chronic conditions to suggest resources for health improvement or symptom mitigation
4. Compliance
• Monitor and communicate changes in aca, ERISA, HIPAA, COBRA, CAA, MHPAEA, and applicable state laws like pa152 and pa106.
• Advise on nondiscrimination testing and parity analysis
5. Service, claims and employee advocacy
• Serve as primary escalation point for claims, billing, and vendor disputes
• Year-round employee support for coverage and access questions
• Conduct quarterly stewardship meetings; review experience and recommend proactive actions
• Strategy for employee engagement during open enrollment.
• Identify how team will support through methods such as in-person or virtual engagement.
6. Technology, data and reporting
• Support benefits-administration and enrollment technology integrated with the organization's payroll/HR systems, list connected carriers and associated costs.
• Deliver regular financial and utilization reports with clear executive summaries
• Benefits management platform for subscribers.