Third Party Administrator Services

The vendor is required to provide third-party administrators with network and peripheral options to handle the day-to-day operations of the programs under the county’s oversight.
1. Workers’ compensation claims
•    Include provider network options and assist the county in procuring network facilities and doctors approved to provide workers compensation services within the state. 
•    In cooperation with any managed care firm(s) the county may contract, provide monitoring of treatment programs recommended for employees by physicians or specialists by reviewing all reports prepared by treating physicians, and by maintaining contact with medical case managers or treating physicians as may be appropriate.  
•    Review and process all workers' compensation claim in accordance with the requirements of the division of workers' compensation and the state's workers' compensation laws, including determination of compensability of reported injuries and illnesses. 
•    Determine eligibility for and authorize payment of medical benefits, as well as compensation for temporary and permanent disability, utilizing any medical sources or advisory boards, as may be deemed necessary and desirable.
•    Maintain a complete claim file for each reported accident and injury that shall be available for web-based review by the county at any time
•    File all reports, forms and documents as required by the department of insurance, center for medicare and Medicaid services (CMS) and other regulatory agencies in a timely and accurate manner, including the annual self-insured reports 
•    Report all qualifying claims to the appropriate excess insurance carrier(s), monitoring claims for potential reporting qualifications.
•    Coordinate investigations of litigated claims with attorneys approved by the county and, where appropriate, with adjusters and attorneys of the excess insurance carrier.
•    With approval of the county, arrange for independent investigators, independent medical exams or other experts to the extent deemed necessary in connection with processing the qualified claim or loss.
•    Monitor the treatment programs recommended for employees by physicians, specialists and other health care providers by reviewing all reports prepared by them and maintaining such contact with these providers as may be appropriate.
•    Investigate and pursue subrogation possibilities on behalf of the county for workers' compensation claims. 
•    Adjusters will email and contact by phone all injured employees on all medical only and indemnity claims, the medical provider and the county within two (2) working days of the claim.
•    Conduct documented file reviews by the claim supervisor every three months (or more frequent) on all lost time files over $25,000.  
•    A minimum of quarterly claims reviews with the county shall be conducted virtually or on-site as requested by the county.
•    Provide telephone or email responses to employees and county inquiries within 24 hours of receipt.
•    Attend hearings as required.
•    Pay indemnity benefits on admitted cases in a timely manner. 
•    Obtain medical verification on continuing disability before making payment.  
•    Calculate medical impairment accurately; review calculations with the risk manager based on a determination that the claimant has reached maximum medical improvement
2. Auto, casualty, property claims
•    Assist the county in processing and resolving auto liability claims against the county involving property damage and bodily injury. 
•    Coordinate handling of property damage claims and bodily injury claims arising from the same incident.
•    Provide the county with settlement recommendations. 
•    Bodily injury claims, provide medical expert review of prior injuries, medical treatment records, and the underlying facts of the claim.
•    Assist the county in processing damage claims against other parties where the county is not at fault.
•    Assist the county in the processing and resolving incidents of county property damage, including coordination with insurance carriers, estimators, and vendors. 
•    Review and advise availability of coverage under the provisions of the county’s various insurance policies.
•    Investigate and pursue subrogation possibilities on behalf of the county for auto liability claims. 
•    The county will select litigation attorneys as required and participate in developing litigation strategy.
•    Report claims to the excess carrier in accordance with policy requirements, monitor all recoveries due and report status as required.
•    Establish and update claim reserves. files will contain copies of the adjuster’s reserve worksheet.
•    Conduct documented file reviews by the claim supervisor every month (or more frequent) on all claims excluding report only.  
•    A minimum of quarterly claims reviews with the county shall be conducted virtually or on-site as requested by the county.
- Budget: $566,292.67

- Contract Period/Term: 1 year
- Pre-Bid Meeting - Non-Mandatory Date: Aug 26, 2025
- Questions/Inquires Deadline: September 02, 2025