ADVANCED RISK MANAGEMENT TECHNIQUES, INC
REQUEST FOR PROPOSAL
(RFP)
AUDIT OF
SELF-INSURED
LIABILITY CLAIMS
Notice:
All questions relative to this RFP should be directed to:
Entity’s designated contact for this project
Date
C:\HP Documents\Claims Audit RFP's\ARMTECH-Liability claims RFP.doc
23701 Birtcher Drive, Lake Forest, CA 92630-1783 (949) 472-8324 •FAX (949) 472-9228• Consultants
ADVANCED RISK MANAGEMENT TECHNIQUES, INC.
23701 Birtcher Drive, Lake Forest, CA 92630-1783 (949) 472-8324 •FAX (949) 472-9228•
Independent Consultants
ADVANCED RISK MANAGEMENT TECHNIQUES, INC.
TABLE OF CONTENTS
General Background ...... 1
Purpose ...... 1
Additional Objectives ...... 2
Provisions ...... 3
Proposals ...... 3
Selection Process ...... 4
C:\HP Documents\Claims Audit RFP's\ARMTECH-Liability claims RFP.doc1
ADVANCED RISK MANAGEMENT TECHNIQUES, INC.
REQUEST FOR PROPOSAL
<Entity> is seeking professional service proposals from qualified firms to provide an audit of its liability program claims.
General Background
This section should describe the entity’s self-insurance program. Specifically:
1.The length of time it has been self-insured.
2.The self-insured retention (if any) it maintains.
3.The makeup of the entity. For example, if the entity is a pool, the number of members should be given; or, if a private business, the type of product it produces.
4.A description of the funding mechanism used to pay claims.
5.The average claim count experienced for the past five years.
6.Number of open claims.
7.The name and address of the third party administrator (TPA) used to administer its claims (if applicable).
Purpose
In this section, clearly state why you desire an audit and what information you expect to receive from the audit.
The objective of the liability claims audit is to assess the efficiency and effectiveness of:
1.Present contract arrangements with the TPA.
2.Claims administration exhibited by the TPA.
The ultimate goal of the audit is to:
1.Improve the efficiency and effectiveness of claims administration.
2.Ensure compliance with all contracts and procedures.
3.Identify any claims payment errors.
4.Identify exceptions to standard cost control procedures in the processing of claims.
Additional Objectives
Use this section to list any ancillary concerns you wish addressed in the audit.
The audit should also include, but not be limited to, the following:
1.Review of Agreements between <TPA> and <Entity> (if applicable).
2.Review of overall claims handling including mail handling, file setup, diary and paper flow.
3.Review the accuracy of claim settlements.
4.Procedure for identifying, tracking and obtaining subrogation recoveries.
5.Aging or outstanding checks for payment of claims and determination of final disposition.
6.An assessment of the quality of service provided by the claims administrator.
7.Whether sufficient staff is assigned to adjust <Entity> claims and whether that staff devoted sufficient time to ensure that the claims are properly adjusted.
8.Qualifications of staff who handle <Entity> claims.
9.The reasonableness of case reserves.
10.The quality of investigations.
11.Adequacy of file documentation.
12.Litigation management.
13.Reasonableness of the fee.
14.Whether a performance-based compensation plan should be used.
The above list presents the general issues <Entity> would like reviewed. Your proposal should list other subjects that should be evaluated.
Provisions
In this section, specific characteristics of the files to be reviewed should be listed. The actual files chosen to be audited can be determined by the entity or by the auditor. You may also ask the auditor to identify a sample size that will provide a certain confidence that problems have been identified.
The audit will review claims paid on behalf of <Entity> by the claims administrator. The claims review will be for the period to present. Claims will be chosen randomly regardless of the dollar amount for those claims totaling less than $25,000. Forty percent (40%) of claims over $25,000 will be audited (approximately ___ claims). A list of claims over $25,000 is attached.
A draft report will be completed and submitted to <Entity> by <due date> with a final report due by <due date> .
Proposals
Written proposals are being requested from firms qualified to perform all required auditing services. Proposals should outline what the auditing firm will do for <Entity> in all areas of service requested. All proposals should include, as a minimum, the following three sections:
1.Scope and Approach. Describe the specific areas you will examine. Identify the timing of each major task and requirements for data or assistance from <Entity> staff.
2.Qualifications. Describe the scope and approach of previous similar audits by the individuals who would actually be doing the work. Include a resume of each such individual, indicating active membership in any professional organizations. Include a listing of previous audit clients with their addresses and telephone numbers.
3.Fees. Clearly indicate your fee for these assignments. A “maximum not-to-exceed amount” is needed, including out-of-pocket expenses. Your fee should consider the auditing of _____ open and _____ closed claims.
<Number of copies> of your proposal must be submitted no later than ____ p.m. on , 20__, to:
<xx>
<xx>
<xx>
You should determine the number of people who will review proposals. Each person should have his/her own copy of the proposal.
Selection Process
The right is reserved to reject any or all proposals and to waive technicalities, and to award a contract to the firm offering the most favorable terms in the opinion of <Entity> .
The contract will not necessarily be awarded to the firm with the lowest fee. All proposals will be evaluated on their total content and not on any one factor. Some of the items to be considered are:
$Fee
$References
$Ability to perform
Questions regarding this Request for Proposal may be directed to <Entity Designee for this project> at <Designee phone number>
C:\HP Documents\Claims Audit RFP's\ARMTECH-Liability claims RFP.doc
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