Third Party Administrator Auto Claims Handing Services

The Vendor is required to provide third party administration services for automobile claims for all institutions.
- Claims Handling Services shall include:
- Contractor must be in compliance with all state department of insurance claims handling requirements; claims handling services will include, but are not limited to:
- Adjust and manage claims in accordance with established university policy and applicable state department of insurance state requirements and rules;
- Complete and document three/four-point contact for each claim (employee, claimant and witness), if applicable, within 24 hours of receipt of the claim;  
- Make and document daily attempts (unsuccessful and successful) to complete recorded statement as soon as possible to finalize the claim investigation and make the appropriate liability determination;
- Correspond and strategize with university;
- Receive approval from university prior to denying any claim.
- Complete claim investigation promptly.
- Seek and receive approval from university prior to assigning outside vendors on any claim; requesting services could include, but are not limited to private investigation and medical review services where necessary;
- Identify and take necessary steps to report potential fraud to the state department of insurance;
- Use surveillance, following approval from university, where length or extent of injuries is questioned;  outside investigation services, such as a private investigator, will be employed only where necessary;  documentation of assignment will include specific reasons for referral;  direction and control will be exercised over the investigator’s activities;
- Analyze medical documents and correspondence promptly upon receipt and take appropriate action based on the analysis and its effect on the claim;
- Maintain accurate, current and professional documentation on each claim;
- Respond to telephone or written inquiries from attorneys, injured claimants, and university staff;
- Assign a value for adequate reserves based on generally accepted claims handling procedures;
- Assist and cooperate with the university, university’s office of general counsel, and the office of the attorney general on any claim that is in the dispute resolution process or litigation.  
- Identify and pursue subrogation recovery opportunities.
- Provide a claims reporting system capable of receiving claim notices twenty-four (24) hours a day, 365 days per year, and capable of integrating the appropriate data entry into a risk management information system (RMIS) to begin the claims handling process from the university and its institutions.
- Claims reporting system shall be capable of generating “real time” reports to analyze claims handling performance;
- Provide the university with appearance hours as needed at no additional charge to address issues associated with claims handling activity or other aspects of the related services in the contract;
- Meet quarterly with the university if necessary to discuss claims and processes on open and closed claims.   
- Forward reports on claims in litigation quarterly monthly to the university;
- Maintain accurate reserves and provide reserve reports to the university upon request.
- Payment Services
• Providing a check writing system, system must provide, at a minimum, the follow information: check number, payee, claim number, entity charged, date, amount, and type of payment.
• Determine liability for and coverage payment of property damage and bodily injury of claimants;
• Provide the mechanisms for the electronic submission and processing of claim payments;
• Have the capabilities to provide an integrated digital imaging system;
• Issue checks tied to a zero balance checking account;
• The contractor must demonstrate appropriate controls are in place to monitor all financial transactions and protect the integrity of the loss deposit account.
• Balance and reconcile university designated account monthly;
• Identify, report, and reimburse overpayments and duplicate payments to the university;
- Miscellaneous services
• Provide implementation status reports quarterly to university until program start date;
• Submit to and cooperate with onsite visits by university staff and claims and operational audits performed by third-party consultants or university staff;
• Provide periodic information to and cooperate with the university’s actuarial service provider;
• Provide annual audited financial statements following the end of the university’s fiscal year;
• Provide data as requested by university;
• Provide electronic claims submission to centers for Medicare and medicaid services/ Medicare secondary payer;
• Provide responses to inquiries from centers for Medicare and medicaid services/Medicare secondary payer;
• Provide ad hoc reporting;
• Provide loss run reports quarterly;
• Transmit claim and payment information daily to the university at no additional cost;
- An operating budget of $29.1 billion for fiscal year 2024
- Contract Period/Term: 4 years