Employee Health Plan Medical Claims Audit Service

The State of South Dakota Bureau of Human Resources and Administration seeks employee health plan medical claims audit services. The contractor must perform medical and pharmacy claims audits following government auditing standards and industry methodologies, including statistically valid sampling. The selected vendor must verify claims processing compliance with state plan provisions, assess self-reported performance guarantee results, measure processing quality and timeliness, maintain auditor independence, and supply sufficient documentation for the state to validate findings. Only USA organizations operating onshore are eligible to bid, and the vendor will perform the work offsite. Interested offerors must submit all questions by October 12, 2026, and deliver proposals digitally via email or online by October 23, 2026. The provided text does not state the evaluation criteria, contract term, or budget details.