The vendor is required to provide that program manager consulting services.
- Act as program design consultant and at least twice per year prepare a report to the executive committee concerning overall trends and developments in employee benefits, along with a statistical analysis of the fund claims data to identify trends and potential cost containment strategies.
- A written report for inclusion in the executive committee meeting agendas which must include, but not limited to, approval of member plan design changes, TPA administrative changes, industry updates, recommendations and status updates of TPA cost containment programs, communication strategies and claim appeal recommendations.
- The written specifications provided, and confirmation on a quarterly basis that plan documents for each member are up to date and current and that this evaluation is not intended
- Provide field visits to the member local units upon request and authorization of the member, with notification to field representative, if one is appointed.
- A complaint log and each month shall review the complaint log prepared by the TPA and the TPA compliance with the disputed claims procedure.
- Prepare employee communications documents concerning initial enrollment and the annual open enrollment.
- Provide consultant services including but not limited to:
• Individual group data and financial analysis
• Recommendation and review of cost saving opportunities
• Benchmarking o assist in union negotiations
• Perform such other duties as may be reasonably requested by the executive committee.
• The commissioner of insurance permits, the service provider shall handle, to conclusion, all claims and other obligations incurred during the contract period
• Monthly itemization of time and members serviced will be provided upon submission of invoices to the fund.
- Contract Period/Term: 8 Month