Medical Administrative Services Organization (ASO), Third Party Administration (TPA) and Pharmacy Benefit Manager (PBM)

The City of Omaha is seeking a qualified vendor to provide Medical Administrative Services Organization (ASO), Third Party Administration (TPA) and Pharmacy Benefit Manager (PBM) services. The selected vendor will be responsible for administering the City's self-funded medical and prescription drug plan, including integrated prescription drug administration or carve out prescription drug administration. The vendor will be required to provide a competitive proposal, excellent network access, provider discounts, effective clinical/claims management programs, and superior customer service. The scope of work includes plan documents, plan design, network access, management reports, and performance guarantees. Key aspects of the job include: • Providing access to a network of qualified providers, including those serving high poverty areas • Offering monthly claim reports, quarterly utilization and claim reports, and online reporting capabilities • Furnishing monthly eligibility and claims file extracts to the City's analytics reporting platform • Completing a claim repricing exercise and providing allowable amounts for medical files • Providing performance guarantees in areas such as client satisfaction, customer service, and medical discounts • Implementing a new system and providing a smooth transition for City employees and retirees