Workers Compensation Third Party Administrator Services

The vendor is required to provide third party administrator (TPA) services for county’s self-funded workers’ compensation program, nurse triage services, and telephonic case management.
- The TPA shall evaluate claims to determine compensability; determine and apply appropriate cost containment measures; determine the correct payment or rating; evaluate injuries, disabilities and incidents for prompt resolution or settlement.
- Requires the claims administrator to perform reasonable and necessary administrative and clerical work in connection with claims and notices, including the preparation and disbursement of checks or direct deposit written on an account bearing the name of county.
- The TPA shall have the responsibility to select, hire, direct and supervise rehabilitation suppliers, private investigators, physicians for independent medical evaluations, medicare set-aside agreements, and any other vendor or provider deemed necessary for the cost-efficient adjudication of workers’ compensation claims.
- The TPA shall have direct claims reporting availability 24/7, 365 days a year, via a toll free or local phone number dedicated to county only. 
- The TPA shall have each claim triaged by a nurse who will complete the first notice of loss and immediately transmit the first notice of loss to the TPA.
- The TPA will assign a telephonic case manager to each lost time claim. 
- The telephonic case manager will follow the claim until resolution. 
- Assignment to medical only claims are at the discretion of county. 
- The TPA will be required to comply with all conditions of the excess insurer(s) with regard to proper and timely reporting of claims.

- Contract Period/Term: 1 year
- Pre-Proposal Conference Date: August 05, 2025
- Questions/Inquires Deadline: August 18, 2025