Workers Compensation Claims System

The Vendor is required to provide to acquire a proven, cost effective, claims administration software that meets the city’s workers’ compensation program needs and to deliver exceptional services to injured employees and stakeholders.
- Provide a secure web-based, integrated, fully managed claims administration solution that allows claims examiners to manage claims efficiently
- Provide highly secure hosting
- Provide software licenses
- Provide software maintenance and support including any changes to accommodate regulatory requirements
- Provide redundant network operation for disaster recovery for the system as well as data
- Provide best effort information security industry standard protections, to prevent unauthorized use, disclosure, or exposure of city data
- Set up a dedicated database environment for City data and processes
- Provide established Service Level Agreements (SLAs)
- Provide implementation services and support including data conversion and mapping
- Train City staff and TPA users on the software, methodology and maintenance
- Provide claims audit tools allowing management to evaluate the quality and performance of claims staff
- Provide document and image management system
- Payment process functionality that supports and aligns with City’s accounting policies
- Litigation management module to track and administer litigation claims and activity
- Standard and ad hoc reporting of claim, financial, and user data
- Robust external interface competencies.
- The Personnel Department, Workers’ Compensation Division has primary responsibility for managing the claim administration system which includes setting system policies, developing user procedures, managing reference table values, managing correspondence templates, developing workflows, and defining reports.
- Medicare Reporting Interface – This interface takes the CMS information captured in Claims Enterprise (CE) and sends this data to city’s CMS vendor; it works with the CMS Compliance Module.
- Payroll Interface
• Interface for importing lost hours and payment information from City’s payroll system
• Interface for exporting injury on Duty eligibility - Claims Administration Software
• Technical Requirements
• General Usability
• System Logs and Audit Trail
• Vendor Management
• Organization Management
• Employee Management
• Claim Administration
• Document Image Management
• Reserves
• Payments
• File Notes
• Diaries and Reminders
• Letters and Forms
• Medical Information/Utilization Review
• Work Status
• Litigation Management
• Interfaces
• Security
• Batch Processing
• Reports and Dashboards
• Compliance
• Support
• System Documentation
• AI (Artificial Intelligence) support features for claim management and statistics/reporting
- Contract Period/Term: 5 years
- Mandatory Pre-Proposal Conference Date: April 8, 2025
- Questions for Mandatory Pre-Proposal Conference Deadline: March 27, 2025