Employee Benefits Consulting, Third-Party Administration and Managed Benefits Services

The Vendor is required to provide employee benefits consulting, third-party administration, and comprehensive, day-to-day managed benefits services to offering its employees competitive, cost-effective benefit programs and seeks a full-service partnership – a firm that is operationally engaged, and capable of delivering integrated program management across consulting, administration, compliance, and employee engagement.
- Strategic benefits consulting services
1. Strategic plan design and renewal management
• Conduct comprehensive annual market analysis of all benefit lines
• Prepare detailed renewal analyses with cost projections, trend assessments, and benchmarking against comparable state public sector employers
• Develop and present multi-year strategic benefit roadmaps with actionable recommendations
• Market on arc's behalf for all benefit lines on a defined cycle, or as needed
• Negotiate carrier rates, plan design modifications, and contract terms on arc's behalf
• Written recommendations with supporting actuarial or financial analysis for any plan design changes
• Facilitate finalist presentations from carriers when requested
2. Financial analysis and cost management
• Provide monthly financial reporting on self-funded plan performance (if applicable), including paid claims, incurred-but-not-reported (IBNR) reserves, and stop-loss utilization
• Analyze utilization trends and identify cost drivers with recommended interventions
• Actuarial-equivalent cost modeling for plan design alternatives
• Assist in development and ongoing management of annual benefits budget
• Model funding scenarios (self-funded vs. level-funded) with recommendations
• Stop-loss analysis, reinsurance procurement, and ongoing aggregate and specific stop-loss management
3. Carrier and vendor management
• Serve as the primary point of escalation for carrier service issues
• Conduct formal quarterly business reviews (QBRS) with primary carriers
• Monitor carrier performance against contracted service level agreements (SLAS)
• Manage carrier and vendor contract renewals and renegotiations
• Written carrier performance scorecards at least annually
4. Benchmarking and competitiveness
• Provide annual benchmarking of arc's benefit program against comparable public sector employers
• Reference and incorporate publicly available plan data from similar entities
• Identify gaps in coverage or competitive disadvantages and recommend supplemental and voluntary benefit offerings appropriate for arc's workforce demographics and in accordance with industry trends
• Industry trend reports, legislative updates, and market intelligence on a quarterly basis
- Third-party administration (TPA) services
1. Medical claims administration
• Adjudicate all medical claims in accordance with plan documents and summary plan descriptions (SPDS)
• Administer and apply preferred provider organization (PPO) and network access agreements
• Manage pre-authorization, utilization review, and case management programs
• Administer disease management, care management, and high-cost claimant programs
• Coordinate Medicare secondary payer (MSP), subrogation, and coordination of benefits (COB)
• Maintain HIPAA-compliant claims data systems and provide plan sponsor access to claim-level data
• A member-facing claims inquiry and grievance process
2. Pharmacy benefits management (PBM) oversight
• Manage or coordinate pharmacy benefit administration, formulary management, and PBM CONTRACT oversight
• Conduct periodic PBM market analysis and contract renegotiation
• Specialty drug management and prior authorization programs
• Deliver transparent pass-through pricing and full rebate disclosure to arc
3. Stop-loss management
• Procure and administer both specific and aggregate stop-loss coverage
• Manage specific stop-loss claims filing and recovery processes
• Provide monthly reporting on stop-loss corridor and aggregate attachment point tracking
• Coordinate with stop-loss carriers on large claimant management
4. Cobra and continuation coverage administration
• Issue all cobra qualifying event notices within required timeframes
• Collect and remit cobra premium payments
• Maintain cobra participant eligibility records and coordinate with carriers
• Provide arc with monthly cobra enrollment and payment status reports
• Ensure full compliance with cobra regulations, including election period tracking
5. FSA and HSA administration
• Administer flexible spending accounts (FSAS) for health and dependent care
• Coordinate health savings account (HSA) banking relationships and contribution management
• Issue debit cards, process reimbursement claims, and manage substantiation requirements
• Provide employee portals for account balance access and claim submission
• Handle IRS compliance reporting (forms 5500, etc.) related to FSA programs
6. Eligibility and enrollment administration
• Maintain plan eligibility records and interface with arc's HRIS and payroll system
• Process all enrollment, change, and termination transactions in a timely manner
• Conduct dependent eligibility verification audits (on enrollment and periodically)
• Manage qualifying life event (QLE) processing and documentation
• Coordinate with all carriers on eligibility file feeds
- Managed benefits services
1. Benefits administration technology
• Integrate a benefits administration platform supporting online open enrollment, new hire enrollment, and life event changes
• Integrate with arc's HRIS and payroll system via automated data feeds
• An employee self-service portal accessible via desktop and mobile
• Maintain a decision-support tool to assist employees with plan selection
• Carrier connectivity (EDI file management) for all benefit lines
• Maintain reporting, audit and reconciliation tools for monthly carrier invoicing
• Support aca tracking, affordability testing, and 1094-c/1095-c reporting
2. Employee communication and education
• Develop and distribute annual open enrollment materials (print and digital)
• Conduct on-site or virtual benefit fairs and enrollment support sessions
• Create year-round employee communications: newsletters, plan updates, regulatory notices
• Develop and maintain an employee benefits microsite or portal
• New hire benefits orientation materials and onboarding support
• Offer a dedicated employee benefits helpline staffed by knowledgeable benefits counselors
• Produce multilingual materials if requested for diverse workforce needs
3. Compliance and regulatory management
• Monitor and advise on all applicable federal and state benefits regulations (aca, HIPAA, cobra, FMLA, mental health parity, no surprises act, etc.)
• Provide arc with timely written compliance alerts and action items via an online dashboard and routine communications
• Draft, review, and update summary plan descriptions (SPDS), certificates of coverage, and plan documents
• Prepare and distribute all required participant notices
• Coordinate and support form 5500 filings, wrap documents, and compliance reviews
• Conduct an annual compliance calendar review with HR leadership
• Assist with DOL or IRS audits or compliance inquiries as needed
4. Wellness and population health management
• Design and implement an evidence-based employee wellness program aligned with arc's culture and workforce demographics
• Coordinate wellness incentive programs and integrate with benefit plan design
• Provide biometric screening, health risk assessment, and chronic condition management programs
• Evaluate wellness program ROI and present annual outcomes reporting
• Partner with EAP and behavioral health vendors to address whole-person wellness
5. Data analytics and reporting
• A monthly benefits dashboard with key metrics across all plan lines
• Deliver ad hoc and scheduled reporting on claims utilization, enrollment, and cost trends
• Predictive analytics identifying high-cost claimant risk and population health trends
• An annual benefits program performance report for leadership
• Benchmarking data reports comparing arc's costs, utilization, and plan design to peer employers
• Deliver data in formats compatible with arc's reporting tools to support census and retirement plan valuation processes
6. Billing and premium reconciliation
• Audit all carrier invoices monthly and reconcile against eligibility records
• Identify billing discrepancies and pursue recovery of overpayments on arc's behalf
• A monthly billing summary report to arc finance.