Third Party Administrator for Workers Compensation Claims and Services

The vendor required to provide third party administrator for workers' compensation claims and services for optional program structures:
1. Option one
•    Continue its current fully insured program with a third-party administrator handling and paying all claims.
2. Option two
•    Become self-insured for all new claims with a third-party administrator handling all past open claims.
- General responsibilities
•    Prepare and submit timely filings with the workers compensation board 
•    Comply with all laws and regulations regarding workers compensation benefits and health benefits provided thereunder.
•    Establish and maintain complete claims files for each claim in electronic form.
•    Review, process and pay medical and indemnity claims on a timely basis.
•    Implement and maintain a claims payment process, including payment authorization procedure, structure of checking accounts, fund replenishment procedures, and internal audit of payments.
•    Schedule all independent medical examinations of claimants as required by your claims team, outside counsel or the town and its separately retained experts.
•    Track all medical services subject to state or federal surcharges, pay the surcharges and submit all associated government forms.
•    Perform all tasks required of medical secondary payer reporting.
•    Prepare and distribute 1099 forms for all vendors every calendar year. 
•    Pursue all second injury fund, subrogation or other recovery opportunities. 
•    Review any workers’ compensation board assessment billing or penalty notices and approve for payment if accurate. 
•    Timely notify the town and its insurance carrier about any covered claims. 
•    Advise the town continuously about actions and procedures that will result in efficient resolution of claims and control of cost to the town. 
•    Advise the town on ways to mitigate costs, including safety training, identifying disturbing claim patterns, better equipment, etc. 
•    Advise the town on acceptance or denial of claims, the plan of action on each claim, and setting reserves for future payments.
•    Obtain prior town approval of settlement of claims over $10,000 and advise the town of settlement of all other claims. 
•    Provide loss information to the town on a scheduled basis. 
•    Provide quarterly cumulative loss and experience reports. 
•    Provide analytical safety reports with data inputs requested by the town. 
•    Cooperate in developing new reporting with town agents including its insurance advisors and brokers. 
•    Permit town read only access to all of its claim’s data in real time.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: November 13, 2025