Customer Success Story
Selecting a Claims Auditor at a 99.5% Confidence Level
Challenge
No auditor could meet a 99.5% confidence level across six benefit lines
A Fortune 500 defense contractor needed assistance in identifying vendors and their capabilities around claims accuracy audits on six different benefit lines (e.g., medical, dental, etc.).
Our client required that the winning vendor be able to accommodate a 99.5% confidence level with an associated 4% confidence interval. This requirement resulted in large required sample sizes for each benefit line.
Solution
Building a statistical RFP framework and running a full vendor search
SBA delivered the following scope of services:
- Performed statistical sample size calculations based on the confidence level requirements
- Worked with our client’s resources to define the service set
- Researched, identified, and contacted potential vendor partners
- Worked closely with each of the vendors to quantify how the 99.5% requirement affected their ability to perform the audit and associated pricing
- Assisted client in understanding the industry, including recent trends, emerging vendors, and other important factors
- Created an RFP and executed a full search process
- Attended and facilitated finalist workshops
- Negotiated the contract and service-level agreement terms
Results
Selecting two vendors to audit all six benefit lines on time and on budget
Our client chose two partner vendors as a result of the search and associated analysis. One vendor was engaged to manage the audit of the medical and pharmacy benefit lines and the other vendor to manage the audit of the four other benefit lines. The project came in on time and on budget despite the significant effort expended in helping the vendors understand why our client desired to audit such a large sample of claims.