Workers Compensation Third Party Administration Services

The vendor is required to provide third party administrative services for the city’s self-insured workers’ compensation program and provide nurse case management for the city’s return to work program.
- The city’s workers’ compensation program is self-insured (SI) on a third-party administrative services only agreement for active city claims with injury years 2003 to present.
- Must recognize that the city is a unique employer that will require significant partnership, attention to detail, innovative thinking and strategy related to its workers’ compensation processes.
- Must be able to efficiently receive, process, analyze and review all claims filed under the city’s workers’ compensation program.
- Must have a robust plan in place for pharmacy benefit manager (PBM) services, including a mechanism for passing on drug rebates and negotiating lower drug costs through a formulary strategy with attention to possible specialty drugs.
- Must have significant familiarity with firefighter cancer claims in the state, and a willingness to partner with the city and the city’s commercial insurance TPA on innovative ways to monitor and pay these claims.
- Must be willing to include performance guarantees, putting fees at risk, for accuracy and timeliness related to claims processing, bill review, and PBM services.
- Provide periodic report summarizing those claims processed during the period. Individual claims showing loss payments, expenses, and assigned reserves to indicate expected future costs.
- Provide access codes and training to allow employer to view certain program and claim data via a secure internet connection.
- Provide annual service organization controls (soc1) reports.
- Provide telephonic nurse case management on selected claims; providing communication with the injured worker and relevant medical provider.
- Provide case management services to employees with restrictions, in order to assist such employees in their rehabilitation and return to work plans, goals and objectives.
- Coordinate functional capacity evaluations, ergonomic-safety assessments of jobs, and on-site transitional work services as needed, on a timely basis and provide written documentation to the return to work (RTW) coordinator and other relevant parties.
- Recommend and facilitate reasonable accommodations for workers, including ergonomic jobsite modifications, as may be necessary to ensure that the worker is enabled to safely perform essential job functions.

- Contract Period/Term: 3 years
- Questions/Inquires Deadline: January 14, 2026