Metroplus Health Plan, Inc.

Buyer seeks one or more actuarial consulting firms to provide services related to health insurance operations. Services include calculation of unpaid claims liabilities, development of rate setting methodologies, review of medical expense documentation, and premium rate development for various insurance products. Buyer requires ongoing professional consulting services for multiple government and commercial health insurance programs covering over 650,000 members.

• 3/27/2025 - Pre-Proposal Conference Call RSVP
• 3/28/2025 - Pre-Proposal Conference Call
• 4/2/2025 - Proposer Questions Due
• 4/18/2025 - Proposal Due Date

• MWBE Utilization Plan, Waiver, or MWBE Certification
• Five years experience as supervising actuary for major health plans
• Experience in review and analysis of health benefit plan rate filings

• Prepare monthly unpaid claims liabilities with 10-day turnaround
• Attest to financial reports and provide benchmark analysis
• Prepare and attest Medicare Advantage Bid documents for CMS
• Develop Medicare benefit summaries and premium rate settings
• Prepare ACA Individual Rate filings with actuarial memorandums
• Prepare Large Group Rate filings with supporting documentation
• Develop medical expense documentation and cost assumptions
• Design innovative payment arrangements with providers
• Analyze risk-sharing agreements and adjust premiums accordingly
• Prepare and attest documentation for new insurance products