Third Party Administrator Claims Services

The Vendor is required to provide for third party (TPA) claims administration services and related services for lines of coverage including but not limited to law enforcement, multiline, property, 1st party auto, ancillary policies replacing coverage with state counties authority.
- Administration
•    Record, establish and maintain a file for each claim. 
•    Provide reports on and analyze all claims, and provide complete claims adjustment services, including fraud identification.
•    Maintain claims files and implement a records management system, which includes retention and destruction of files.
•    Establish and manage a controlled disbursement account funded by county for the TPA’S use in payments within the settlement authority limit. 
•    Provide check issuance for all settlement and outside consultant and vendor payments.
- Settlement of Claims
•    The TPA will contact the director of risk management department and the legal department or designee, respectively, with its settlement recommendation and obtain county’s approval to negotiate and resolve any claim.
•    The TPA shall settle bodily injury and property damage aspects of the claim as one “global” settlement, unless authorized differently by county.
•    The TPA shall keep the director of risk management department and the legal department fully informed of all significant developments in assigned matters.
•    The TPA will report to county on any assigned claims determined to present a conflict of interest. The TPA or its former employees will not represent county where a conflict might exist, without an expressed written and executed waiver from county.
•    The TPA will notify existing claimants by letter of newly assigned adjuster and contact information within thirty (30) days of start of contract.
•    The TPA shall manage and administer liability and property on open existing claims, or as assigned by county, from cradle to grave.
- Risk Management Information System (RMIS)
•    Must integrate with county risk management information system, origami.
•    Clarify any additional fees that would be charged for additional functions or features county may require. For example, reporting features, data formatting or accounting needs.
•    The TPA’S portal must be capable of tracking claimant name, claimant contact information, claimant birthdate, social security number, department, status (open/closed and date closed), loss date, report date, whether litigated or not, assigned examiner and manager, plan of action, claimant's description of loss, nature of injury, injury type, reserves, reserve changes, claims expenditures and payments made (including settlement payments and payments to defense counsel), payment categories, accident location, detailed description of incident, incident type (e.g., auto liability, general liability, property damage, etc.), description of injury, claim amount, deadline for filing suit, litigation hold notices, lawsuit venue and case number, attorney representation, whether matter was reported in audit letter or quarterly report, and the county’s file number, total cost of claims, total number of claims incurred, and other statistics. In addition, claims, complaints, correspondence, emails from claimants and counsel, and other types of documents should be uploaded into the database. 
•    County’s risk management department, county’s accounting department, and county’s legal department must have access to TPA’S portal.
•    The TPA’S portal must be capable of exporting report information in various formats including excel worksheets.
•    The TPA’S portal must be capable of real-time tracking claims jointly and separately for county provided services and county contracted services. The TPA’S portal must be capable of generating reports of incidents based on this information that it tracks, including but not limited to incidents by county unit number, vehicle identification number, accident location, type of claim, property location / identification number.
•    The TPA must be able to generate checks for all payments from county’s controlled disbursement fund account. Provide detailed information regarding funding requirements, process, and procedure.
- Reserving
•    Establish a reserve for each claim and describe practices and methodology.
•    Establish a diary system for all claims to determine adequacy of reserves.
•    Reserves must be established to reflect a claim’s full exposure potential.
•    Establish an on-going and prescheduled reserve review procedure.
•    Facilitate reporting of reserve amounts according to the excess insurers’ criteria.
•    County reserves the right to increase or decrease reserve amounts based on recommendation by the risk management department and/or legal department. 
- Claims Handling
•    Establish a file for each claim. Fully and promptly investigate all claims within 24 hours of receiving, working with county risk management department staff as appropriate and including conducting field investigations, and obtaining witness statements and all relevant documents including medical records and the reports of law enforcement and other governmental agencies. The TPA must also investigate fraud and utilize all appropriate investigation methods.
•    Accidents where there are serious trauma injury requiring hospitalization, catastrophic accidents involving fatalities, paralysis, or loss of limb or where there is serious injury to a minor child will be responded to an investigation begun within 2 hours after notification by county.
•    Provide 24-hour/7-day-a-week on-call field investigation services.
•    Provide field investigators with mobile phones to communicate with county staff during an incident and immediately after an incident.
•    Provide, through the TPA’S portal, a written chronology of all actions taken with respect to each claim investigated and prepare regular periodic reports to county, on a timetable established by county at the inception of the claim.
•    Adjust, settle, or defend all claims within the discretionary settlement authority limit granted by county and issue settlement checks directly within the authority limit.
•    Adjust, settle or defend all claims in excess of the authority limit with approval of county.
•    Assist outside defense counsel with investigations and attend hearings or depositions as required. 

- Contract Period/Term: 2 years
- Non-Mandatory Pre-Proposal Meeting Date: September 18, 2025
- Questions/Inquires Deadline: September 24, 2025