Care Complaint System

The vendor is required to provide care complaint system to ensure health plan members have access to equitable, high-quality, timely, and affordable health care within a stable health care delivery system.
- Solutions that demonstrate an ability to meet the following areas of need:
1. Help center program needs
•    A consolidated case management solution that can intuitively and consistently manage both provider and consumer complaint functions, with minimal user engagement. 
•    Each complaint domain has its own distinct set of case types, case type workflows, case type business rules, and case domain users. 
•    The ability to create a bulk-claim parent case (and link associated documents), then divide the documents amongst multiple child sub-cases that can each be assigned to a unique case manager and case analyst.
•    Reducing complaint processing time, leading to faster resolution of user complaints related to health care services, financial responsibilities, and health care education by:
o    Reducing average case processing time
o    Automating case creation through implementation of an external user portal
o    Enabling external users to interact with their case via a portal to check case status and communicate with case analysts
o    Providing modern, low-code configurable automation that will quickly streamline the overall case management function and support process re-engineering at the speed of business need.
•    Provide consumers, providers, and health plans with real-time case tracking for status, communications, and notifications to improve operational efficiencies by reducing contacts from members and providers requesting case status information.
•    Provide guided data entry and data validation to improve quality for help center real-time data trend analysis and response activities.
•    Provide workflow automation and workload management that enables case analysts to process more complaints and reduce the need for manual processes. 
•    Provide more efficient complaint resolution, enhanced communication and transparent resolution process by enabling rapid low-code configuration of functional capability. 
•    Comprehensive analytics to identify trends and recurring issues, detailed reports for internal department reviews, audits, and compliance documentation.
2. Technology and innovation needs
•    Enable it staff to manage and modify a solution without the need for manual coding by leveraging low-code configuration capabilities to increase developer throughput by up to 500% and enable it to operate closer to the speed of business need, rather than with a need for business speed. 
•    Implement a platform that ensures information security risks are managed and mitigated through platform governance and security controls. 
•    Minimize the time required to manage underlying infrastructure, ensure it is up to date for all web and database services as well as the low-code platform itself.
•    Minimize disruptions to applications developed on the low-code platform when updates to the infrastructure take place.
•    Streamline backup and recovery operations of the application and data captured by the application.
•    Achieve operational efficiencies provided by a low-code platform that pertain to moving applications between environments, and how problematic changes are rolled back.
•    Leverage a modern case management platform solution, powered by industry-leading low-code technology, to significantly reduce the time it takes to implement new features and functionality, as compared to more traditional software development efforts that may have preceded low-code adoption.
•    Leverage a modern case management platform, deployed within a SaaS model, to enable dynamic scaling of solution architectures to meet increasing case volumes, users and the resulting infrastructure needs.

- Questions/Inquires Deadline: October 13, 2025