Medical Claims Audit Service

The government authority in Portland, OR needs a vendor to perform independent medical, prescription, and dental claims audits of its self-funded health plans. The requested scope requires the contractor to implement quality assurance processes with internal review protocols and error-checking methodologies. Additionally, the contractor must execute a knowledge transfer plan, such as providing a training session on key findings or documenting audit methodologies and corrective action plan monitoring processes to equip County staff with audit insights. The buyer limits eligibility to USA organizations operating onshore. Vendors may perform the work onsite or offsite, and they must submit responses digitally via email or online. The contract period spans five years, and the buyer seeks proposals without disclosing a specific budget. The authority scheduled a pre-proposal meeting for September 02, 2026. The provided text does not outline specific evaluation criteria.