• Aid the City with communications to notify and inform employees / retirees of the upcoming audit, including a description of the process and the documentation required to confirm eligibility for dependent coverage. • Audit the City’s employees’ and retirees’ dependent population for compliance with the eligibility rules outlined in the plans. The audits must be tracked as individual audits for each population and provide statistics per employee / retiree and associated dependent(s). • All communication, processing, and transference of data must remain within the U.S. • Provide a U.S. based Service Center for employees / retirees to call with questions or concerns. Service Center requirements include: o Availability Monday through Friday, 8:00 AM to 5:00 PM PT; o The provision of a dedicated phone line for City employees / retirees; o Live Spanish speaking representatives and language line access for other languages; o Availability of ADA accessibility equipment; and; o The ability to perform incoming as well as outgoing cold transfer of calls to / from the City’s system of record. The City currently uses the Cisco phone system. • Provide communications on behalf of the City to employees / retirees requesting documentation to verify eligibility of dependents of coverage. • As part of the communications and response effort, collect other employee information noted below: o Coordination of Benefits (COB) details including but not limited to dependents with other employer sponsored coverage; • Provide follow-up communications to employees, as necessary. o If employee submitted incomplete documentation to confirm eligibility; and o Final determination notifications of all dependents. • Distribute communication to The City employees / retirees via USPS mail and include a postage paid envelope for documentation return. • Provide a dedicated and secure, U.S. based website for employees / retirees to upload documentation via single sign on (SSO) for applicable populations through the City’s website. • Coordinate on follow-up communications to the employee / retiree population. • Communicate ineligible individuals to be removed from coverage. • Provide comprehensive reporting on the audit results and recommendations, as well as reporting by bargaining unit (up to 45 bargaining units). • Provide online access to the vendor’s portal for authorized staff to view employees’ / retirees’ status as well as view the uploaded documentation from the employees / retirees. • Ability to manage the appeals process by systematically capturing first level and second level appeal attempts since the first and second level appeal may follow different processes. • Support a 30 day appeal period following the termination of coverage date. • Ability to verify any future employee / retiree population acquisitions, as a one-time verification phase. • Provide reporting on performance guarantees weekly for service center services with a minimum of the following: o Member Speed to Answer – 90% within 60 seconds; o Call Blockage – 90% within one business day; 100% within two business days; and o First Call Resolution – 90% or greater. • Retain and share data collected from the employees / retirees in a standard, electronic format (Excel, .csv, .txt, etc.). This includes Coordination of Benefits (COB), and other updated demographic information (address, email address, phone number as well as any updated relationship codes due to documentation supplied (stepchild, guardianship, etc.). • Retain and share documents received from the employee / retiree in a standard, electronic format to be loaded into the system of record. • Retain and share daily call notes received from the employee / retiree in a standard, electronic format that captures date and time of interaction, type of contact (phone, email, chat etc.) and a summary of the interaction. • Determine and share the disposition of employee’s / retiree’s dependent(s) audit (including Domestic Partners and grandchildren). The information must be shared in a standard electronic format (Excel, .csv, .txt, etc.). • After documents are scanned, stored, and shared, dispose of documents using a HIPAA compliant solution/vendor. Certification of disposal is required. • Store documentation electronically to follow retention policy. • Provide electronic copies of all documentation collected in this effort.
