Employee Healthcare Administration Services

2026-11-03

• Medical Claims Administration and Program Services • Accurate and timely claims processing • Case Management and Behavioral Health Services • Care Management and Chronic Condition Services • Wellness and Well - Being programs that encourage member participation , resulting in improved outcomes • Coordination with the County ’ s preferred Kidney Dialysis Provider , HealthChoice • Onsite Clinic Management at no cost to the County or to the employee with integration and data sharing • Specialty Drug administration • Provider Network Administration • Access to national and local contracted networks including physicians , hospitals and ancillary providers • Maintain a comprehensive , affordable , and high - quality provider network • Ensure cost sustainability through efficient claims adjudication and network contracting • Improve transparency in pricing , contracting , and utilization data • Maintain a highly accurate provider lookup tool • Data and Reporting • Ease of reporting , including dashboards with the capability to review utilization results for the County • Willingness and ability to provide claims data to the County and its consultant on a monthly basis • Real - time integration with carve - out vendors , including data aggregation of medical and pharmacy claims for deductibles , out - ofpocket maximums and stop loss coverage • Detailed management of both clinical and ad - hoc reporting • Online reporting and eligibility access for the County • Billing practices that support the County ’ s administrative support staff and provide accurate invoicing

Tennessee

2026-05-05