Third Party Administrative Services

The vendor is required to provide third party claims administrator with a proven track record to manage its workers’ compensation, general liability, and auto claims.
•    Provide exemplary administrative service and cost-effective management of workers’ compensation, general liability and auto claims. 
•    Provide a dedicated worker’s compensation adjustor who will only handle the school district’s claims. 
•    Provide a designated adjustor for general liability and auto claims. 
•    Assure the school district’s injured workers’ medical care is provided in a timely manner using a network of high performing and responsive providers to ensure that the highest quality medical care, management, and active consumerism is rendered for the achievement of optimum results. 
•    Provide flat annual fee pricing and transparency of all revenue generated to the claims administrator derived from the handling and services of the school district’s workers’ compensation program, general liability, and auto claims. 
•    Provide reporting capabilities to evaluate the success of the program and whether the awarded contractor’s staff, medical clinicians, associated services vendor(s), and contracted entities are performing services and achieving the best possible outcomes in an effective and efficient manner. 
•    Provide written documentation of the awarded contractor’s ongoing compliance with its internal quality assurance program.
•    Assist the school district with its continued objective to reduce lost time indemnity and increase the effectiveness of the return to work and stay at work efforts.
•    Proficiently handle claims for the school district’s employees, some of whom are covered by state statute the heart and lung bill provide bilingual speaking individual(s), with Spanish as the second language and make available translation services for additional languages, when required. 
•    Propose fees that include claims that are pending, open, and incurred but not reported yet.
•    Provide the school district access to a “real-time” risk management information system (RMIS) system including adjuster’s notes, claim payments and reserves, formatted loss reports, loss statistics and other relative data. 
•    Provide a minimum of 2 weeks’ notice to agency of any voluntary or involuntary terminated employee that at the time of termination provides any services directly with agency. 
•    Any change in personnel assigned to agency requires prior approval from agency.
- Prior claim files
•    The complete handling of all new and old claims, including pending claims as well as “incurred but not yet reported” (IBNR) claims being handled by the school district’s current claims administrators for dates of loss from prior carrier.
•    It is required that claims data and any and all other documentation (open and closed) associated with all claims occurring with the prior carrier be transferred into the newly awarded contractor’s computer information system to ensure future school district loss runs will contain a complete history of all claim years. 
•    The complete handling and takeover of all worker’s compensation claims, including all old and IBNR claims, must be included in the flat fee. 
•    General liability and auto claims must be included in the flat fee. 
•    The current claims administrator to ensure the successful transfer of claim files and report to the school district within five (5) business days of any failure of the current claims administrator to cooperate with the transfer of claims.
- Workers’ compensation claims management, adjusting, and investigation services
•    Review all notices of injury received from the school district prior to the assignment to an adjuster or nurse.
•    Accept or deny all reported claims for employees’ injuries on behalf of the school district in accordance with applicable workers’ compensation laws.
•    The required investigations as deemed necessary by the awarded contractor, including, if necessary, scene investigations and claimant contact on lost time or restricted duty cases.
•    Make contact with claimants within twenty-four (24) hours of the awarded contractor’s receipt of the claim.
•    Claims requiring medical care, make contact with the employer, injured employee, and clinician (three-point contact) within twenty-four (24) hours.
•    Employ the services of outside professionals to assist in investigations, claims adjustments, etc. as necessary. 
•    Services may include, but shall not be limited to, surveillance, rehabilitation, claim-specific medical care managers, subject matter experts and legal counsel.
•    Payment for these services will be made by the awarded contractor from the school district loss fund as an allocated expense. 
•    strict oversight is expected with respect to reviewing bills for appropriate charges.
•    Provide reports to the school district regarding all medical bills and other services for which a claim is being made for reasonableness and conformity to appropriate medical and surgical fee schedules and network discounts.
•    Prepare and maintain electronic files as necessary for legal defense of claims and or other litigation (such as actions of subrogation) or other proceedings.
•    Pay all claims and expenses in a timely fashion from the school district’s loss fund account, which shall be maintained by the awarded contractor. 
•    Overpayments, fees, interest and civil penalties required due to late payments or adjuster mishandling shall be paid by the awarded contractor unless the error is solely caused by late reporting and misreporting of information by the school district.
•    Attend workers’ compensation hearings and mediations as appropriate or as requested by the school district.
•    Provide online electronic and 24-hour telephonic reporting of employee notices of injury, available to the school district for access tracking.
•    Provide access to a provider network that contains high-quality providers, particularly in key specialties, physical therapy, hospitals, etc.
•    The network should be analyzed annually for cost-effectiveness.
•    Provide a current disaster recovery plan ensuring that services on behalf of the school district will be continuous and uninterrupted.

- Contract Period/Term: 3 years
- Pre-Proposal Meeting Virtual (Non-Mandatory) Date: October 21, 2025
- Questions/Inquires Deadline: October 24, 2025