Third Party Administration Services Workers Compensation Auto and General Liability and 1st Party Property Claims Administration and Workers Compensation Managed Care Services

The Vendor is required to provide claims administration including managed care services.
- Claims Management/Investigation
•    Provide complete handling of reported claims, including but not limited to all tasks associated from set up to closure. Set up for record only claim. The risk manager will advise whether a claim is reported or record only.
•    If during an investigation the vendor determines the existence of a hazardous condition, the vendor shall immediately contact (telephonically) the risk manager.
•    Provide a reporting procedure for accidents occurring after normal business hours including weekends and holidays.
•    Determine compensability or coverage position for all reported claims. Determination shall be made within 72 hours of receipt of necessary facts.
•    The risk manager must be advised prior to issuing any denial of benefits/coverage.
•    Determine initial claim reserves, review on a continuous basis and update accordingly.
•    Index all claimants for multiple claims and possible causation unrelated to work injury such as an auto accident.
•    Refer potential fraud to the risk manager for review.
•    All settlements within the city's sirs must be approved by the city's insurance commission. The vendor will prepare a settlement authority request (SAR), in a format acceptable to the city, and submit each SAR to the risk Manager one week prior to the Commission meeting.
- Workers' Compensation Claims
•    Advice the city's risk manager if a medical bill has been submitted for payment which has not been repriced (in or out of network) by the office. 
•    Complete all applicable state & federal filings on behalf of the city. Examples include but not limited to: agency, medicare, etc.
•    At the direction of the risk manager, assist with return-to-work/ modified duty efforts between TCNM/NCM, medical providers & employees.
- Managed Care Services
•    Provide integrated managed care services, including but not limited:
•    Telephonic case management and field case management
•    All nurse case managers must be registered RNs
•    Integrated electronic system between case manager and claim adjusters to assure file documentation is complete.
•    Provide Network Access
•    Perform all repricing services pursuant to Network
•    Negotiate out-of-network medical bills
•    Provide medical bill review
- Legal Case Management
•    Assist Defense Counsel (internal/external) in evaluating, investigating, and determining the appropriate legal strategy.
•    Advice the Risk Manager if external Defense Counsel is not providing standardized status reports on assigned claims.
•    Subrogation / Salvage
•    Pursue subrogation against third party negligence issues and on behalf of the City. Risk Manager will advise if any subrogation is to be abandoned.
•    Make recommendations regarding salvage matters.
- File Management
•    Maintain an electronic file for each reported and each record only claim.
•    Preserve all documents as required by state statutes and/or regulations. Provide files to the City upon request.
•    Any requests to destroy closed claim files must be forwarded to the Risk Manager for review and consideration prior to destruction.
- Financial Management
•    Prepare all checks or vouchers to satisfy all approved and authorized claims against the City (including allocated claims expense) for Workers' Compensation, General Liability, Automobile Liability and First Party Property Losses including Automobile Physical Damage.
•    When requesting imprest account transfers, provide the Risk Manager and CFO with a listing of proposed transfers by calendar year and line of coverage, along with check registers, void check registers, and adjustment registers, netting to the amount of requested transfers.
•    Supply monthly financial reports to the Risk Manager and CFO detailing, summarizing, and reconciling imprest transfers, claim payments, and other financial transactions (voids, refunds, recoveries, etc.) in the manner specified by the CFO.
•    As directed by the Risk Manager enter financial obligation paid by the City which is attributable to a claim for record keeping purposes only (example - Workers' Compensation - Supplemental Indemnity).
- Risk Management Information System
•    Provide access to an electronic Risk Management Information System (RMIS). The City should have 24-hour access except for maintenance updates.
•    The RMIS should include real time adjuster/TCNM/NCM notes, current financial status (paid/reserve/recovery/incurred broken down by medical, indemnity, and expenses), current status and future action plan.
•    The RMIS should allow access to view the payment system for all claims and services.
•    The RMIS should have the capability to allow the City to extract data from the system.
•    Installation, training, and support services should be available on a start-up basis and throughout the life of the contract.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: September 22, 2025