The vendor is required to provide to manage and administer our workers compensation program for the full spectrum of services related including claims reporting, investigation, medical management, case management, fraud prevention, compliance, reporting, litigation management, and claims resolution.
- Provide high-quality, timely, and cost-effective management of workers' compensation claims, ensuring compliance with all relevant laws and regulations.
- The TPA will be expected to collaborate closely with our internal teams—HR, risk management, employee health clinic, occupational and environmental safety and finance—to ensure that claims are handled efficiently, cost-effectively, and in a manner that supports the overall goals of the company.
- The TPA to implement strategies that reduce claims frequency and severity while supporting injured workers in their recovery and return-to-work.
- Provide a minimum of 6 licenses to agency to access your claim management system.
- Access to adjuster’s notes include comments regarding exposure, disposition plan for claim closure, financial transactions, supervisor’s notes, and any other relevant claim information
- The adjuster will notify agency within 2 business days when return-to-work letters are sent to the claimant, whenever there are changes to the claimant’s work restrictions, and at the time of any permanent work restrictions.
- The adjuster will document transitional/modified duty in the claim file including the degree of disability, work restrictions, and estimated duration of the disability.
- Account manager to participate in quarterly claim reviews with participation of the claims adjuster(s) and, as needed, defense attorneys and nurse case managers.
- TPA will review all medical provider bills for appropriateness of fees charged.
- TPA to recognize, pursue, and collect all potential sources of recovery including but not limited to, second injury fund, stale case, no fault loss transfer and third-party tort actions without surcharges or percentage of savings fees.
- TPA to review and monitor the medical status of employees ensuring compliance with medical treatment guidelines, as appropriate.
- TPA to coordinate claims payment procedures including structure of checking accounts, fund replenishment procedures and limitation on payments.
- TPA to provide a weekly check register detailing expenditures to a designated employee or email group of agency.
- provide claims management to include handling the entire claims process, from initial reporting to final resolution.
- Contract Period/Term: 3 years
- Questions/Inquires Deadline: May 9, 2025