Specifications include, but are not limited to: (a) Recommendations for revising county benefit plans and/or vendor agreements to improve overall cost effectiveness of benefit operations. (b) Identification of health care benefits that could be added, modified or deleted and the estimated financial impact. (c) Identification of new program alternatives and plan structure (i.e. deductibles, copays, near-site clinics, etc.) and the estimated impact on monthly premiums and the overall financial impact on the Benefit Fund. (d) Assist the County with development of insurance premium structures. (e) Comparison of the County plan structure to that of other comparable public and private employers in the local labor market. (f) Identification of alternative plan structures (basic, POS, PPO, etc.) that meet the needs of the employer and bargaining unit (if applicable) that fit within the scope of the County’s Third Party Administration (TPA) providers and the medical community’s processing capabilities. (g) At a minimum, perform bi-annual claim audits which review claims for abnormal pricing, plan compliance, and recovery of overpayments. (h) Assist in the development, evaluation, and selection process of health, dental, and other insurance related Request for Proposals (RFP’s). (i) Negotiate fees and third-party service providers (administrative, stop loss, drug management, utilization management, etc.) in coordination with the County and its contracted vendors. (j) Keep client informed on current legislative and court decisions that may impact the County’s benefit plans and recommend changes that limit County liability and keep in compliance (k) Supply reporting software and provide assistance with all annual ACA reporting (PECOR, 1095C, 1094, etc.). (l) Assist in the development and on-going management of the County’s wellness initiative including, but not limited to health risk assessments.
