Medical Claims Audit

Multnomah County seeks a qualified vendor to conduct a comprehensive audit of its self‑insured medical, prescription, and dental health plans. The contractor will provide independent analysis, stakeholder‑engagement reporting, quality‑assurance processes, and knowledge‑transfer deliverables while ensuring HIPAA compliance and data security. The scope also allows optional follow‑on projects (≤ $10,000 each) and encourages innovative, value‑added services such as predictive analytics. • Perform full‑scale medical, prescription, and dental claims audits of County‑run self‑funded health plans (≈ 2,300 medical and 2,600 dental participants). • Deliver semimonthly progress reports, a 24‑hour issue‑escalation process, and a comprehensive final audit report with corrective‑action recommendations. • Provide knowledge‑transfer training, data‑security compliance (HIPAA/HITECH), and optional innovative analytics or benchmarking services, all within a contract term of up to five years.