Employee Benefits Analytics and Advisory Consultant Services

The Vendor is required to provide employee benefits analytics and advisory services consistent with the set forth.
- The Consultant will work in partnership with the School Division’s existing insurance broker of record.
- The purpose is to improve financial performance and member outcomes in our self-funded medical and pharmacy plans while ensuring compliance and strong data governance.
- Monthly claims intelligence
•    Obtain complete and timely medical and pharmacy claims data sets directly from anthem and any other administrators under appropriate third-party data use and confidentiality documents.
•    Maintain a secure data pipeline and repository that enforces least privileged access and audit logging.
•    Produce a monthly claims report by the 15th calendar day following month end. 
•    The report will include paid claims, allowed amounts, large claimants, high-cost drug utilization, stop loss recoveries, net plan cost, trend and seasonality, plan performance by option, and leading indicators for renewal.
•    Provide an executive one-page summary suitable for board packets and a detailed appendix with drill down exhibits.
- Quarterly projections and risk assessments
•    Complete quarterly actuarial projections of plan year total cost with explicit assumptions for utilization and unit cost trends, seasonality, benefit changes, and enrollment.
•    Provide quarterly IBNR estimates, completion factors, and lag triangles and reconcile to administrator financials.
•    Evaluate specific and aggregate stop-loss attachment points and corridors and advise on any required changes.
•    Identify items that appear out of the ordinary including claim spikes, coding anomalies, changes in catastrophic claimant mix, and new specialty drug exposure. 
•    Flag which items are temporary versus structural and quantify the estimated impact.
- Budget season support and plan design advice
•    Build rate development models that connect projected plan cost, reserves, and contribution strategies to member rates.
•    Develop up to three plan design scenarios each year that balance affordability, equity, and access. 
•    Include projected financial impact and member impact for each scenario.
•    Prepare draft presentation materials and present to the school board staff as requested.
- Coordination with the broker of record
•    Establish a written roles and responsibilities matrix with the broker and the school division covering annual timeline, data stewardship, vendor communications, and decision rights. 
•    Provide technical review of administrator and stop loss renewals and document any variances from expected results.
•    Support the broker with underwriting exhibits, experience files, and independent projections. The consultant will not solicit proposals from carriers unless expressly requested in writing by the school division.

- Contract Period/Term: 3 years
- Questions/Inquires Deadline: September 24, 2025