Medical Claims Audit

Multnomah County is requesting proposals for a comprehensive medical claims audit of its self-insured health plans under RFP-12-2027, with proposals due September 23, 2026 at 4:00 PM PDT and a virtual pre-proposal conference scheduled for September 2, 2026 at 1:30 PM PST. The County encourages participation from Minority-Owned, Women-Owned, and Emerging Small Businesses but does not apply a set-aside or mandatory participation goal.

The scope covers medical, prescription, and dental audits; stakeholder engagement with semimonthly progress reports; quality assurance protocols; knowledge transfer and training; and support for additional projects not exceeding $10,000 individually. The County administers benefits for approximately 6,000 employees, with roughly 2,300 employees and retirees in self-funded PPO medical plans and 2,600 in self-funded dental plans. The primary objective is to ensure fiscal accountability, verify compliance with plan documents, and identify cost recovery and process improvement opportunities.

Proposers must submit fixed fees for all core services and travel, plus standard hourly billing rates by role or expertise level for additional work or extensions. The contract term does not exceed five years. Contractors must carry Professional Liability insurance of $1,000,000 per occurrence/$2,000,000 aggregate, Commercial General Liability of $1,000,000/$2,000,000, Cyber Liability of $1,000,000/$2,000,000, and Workers' Compensation at statutory limits. Contractors must be registered to do business in Oregon at contracting.

Evaluation criteria include programmatic questions worth 75 points and responsible business practice questions worth 25 points, covering methodology, experience, data security, technology platforms, energy conservation practices, equity-focused analysis, and employee wellness initiatives. Cost, expertise, methodology, innovation, and alignment with County needs drive evaluation. The County has budgeted sufficient funds for the outlined services and reserves the right to reject any or all proposals. Proposals must be submitted electronically through the Multco Marketplace system. Questions are due during the designated Q&A period.