Health Insurance Cost and Claims Review Service
Overview
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SUMMARY
DESCRIPTION
The issuing agency in Wisconsin is seeking a vendor to provide health insurance cost and claims review services. The selected provider will perform a complete, independent review of health insurance claims to evaluate billing accuracy and confirm that claims were processed in accordance with the agency’s plan documents.
The scope of work includes reviewing medical, pharmacy, and related claims; identifying potential overpayments, duplicate payments, and incorrect pricing; and assessing the accuracy of provider billing, coding, and claim adjudication. The vendor will be expected to document irregularities, errors, and discrepancies, and provide recommendations for process improvements, recovery opportunities, and vendor oversight practices.
The selected partner will also be responsible for recovering and collecting funds associated with claim inaccuracies through progressive recovery steps aligned with the county. A final report is required summarizing findings, financial impact, and recommended next steps.
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Frequently asked questions
- When is the submission deadline?
- Submissions are due August 19, 2026.
- Who is a good fit for this opportunity?
- Health insurance claims audit and recovery specialist
- Experience reviewing medical and pharmacy claims
- Expertise in provider billing, coding, and claim adjudication analysis
- Capability to identify overpayments, duplicate payments, and pricing errors
- Proven track record in funds recovery and collections support
- Experience serving public sector or county government clients
- Ability to deliver independent reviews and clear financial impact reporting
Analysis generated by Settle AI from the source RFP.
RFP Hunter shows what is open. Settle shows what is forming.
Settle pieces together buyer signals, budgets, contract activity, and the sources your team already monitors. See why an opportunity fits and what to do before the RFP posts.