Third-Party Claim Administration Services

The Vendor is required to provide third-party claim administration services for auto liability, first party property, general liability, professional liability, and workers’ compensation claims.
- Requirement:
1. Third-party claim administration information, background
•    Provide a summary of your company’s experience and financial strength. 
•    Provide a list of your vendor partners which are wholly or partially owned by your company or in which your company has any type of revenue sharing relationship with. 
•    Provide a list of three (3) current public entity clients and their contact information for reference purposes. Please only include references for clients in which you handle all the lines of coverage included. 
•    Differentiators that you perceive set your organization apart from your major competitors. 
•    Provide a summary of your business continuity and disaster recovery plans. (may be attached as an exhibit) 
•    Provide a list of all carriers who have approved your organization to administer claims and specify lines of coverage you are approved for.
2. Claim reporting
•    Capability and various options for 24/7 claims intake including after-hours and catastrophic claims intake
•    Is your claims intake functioning all in-house or is any portion of it outsourced 
•    Provide information regarding any lag time claim set up associated with the various reporting methods. 
•    Confirm your ability to provide auto generated e-mail claim acknowledgments to a designated e-mail recipient list. 
•    Your ability to customize the claim intake script and claim intake data fields per the client’s request
3. Claim management
•    The processes you have in place for adjuster notification of client services instruction changes and ensure continuous adherence to updated client service instructions. 
•    Process, triggers and criteria for transferring a claim from MO to lost time status. 
•    Any dedicated or designated adjuster structure you would recommend for this account and for which lines of coverage assuming an adjuster caseload of not to exceed 125 open files (WC-lost time claims.)
•    Ability to provide the client with tenured adjusters (10+ years of experience) for all lines of coverage with the exception of workers’ compensation medical only claims. 
•    Provide a copy of your best claim handling practices for the lines of coverage
•    Provide your “medical only” definition including total paid medical dollar threshold in which MO claims are converted to “lost time” 
•    Ability to provide an additional workers’ compensation claim category for more complex medical only claims that may not necessarily rise to the complexity of a lost time claim but require more hands-on claim handling than a basic medical only claim. 
•    Process for monitoring and closing out medical only claims. 
•    The invoice amount allowed to be paid on a closed claim. 
•    Agreement to obtain client approval prior to setting initial and subsequent reserve increases of >$25,000 and to provide the client with a clear and concise e-mail outlining the reserve increase rationale and attach a completed reserve increase worksheet along with any other documentation to support the reserve increase (i.e., defense attorney evaluation). 
•    Ability to provide the client with an e-mail settlement authority request on all settlements to include a clear and concise summary of the claim and settlement authorization rationale along with any applicable documents to support the settlement authority being requested (i.e., defense attorney evaluations) 
•    Ability to provide onsite support and onsite adjuster. 
•    Methodology for integrating onsite clinics into the first report of injury treatment site. 
•    Describe your subrogation process. 
•    Organization’s ability to adjust claims in-house in all 50 states. 
•    Agreement to obtain client approval prior to issuing any claim denials to include an adjuster e-mail to the client outlining the rationale for the denial, suggested denial language and include any defense attorney consultation to support the denial (if applicable). 
•    Process for monitoring reserves on open claims. 
•    Confirm the district has ownership of all claim data. 
•    Confirm data format, timeline and post termination export of data files to the district.
4. Litigation management
•    Provide a copy or describe your litigation management best practices 
•    Defense attorney referral process and confirm you will agree to client approval prior to defense attorney assignment. 
•    Adjusters will manage defense counsel. 
•    Provide a sample of your litigation action plan and budget format required to be submitted by defense counsel, 
•    Legal bill review process.
5. Claim, risk management, and banking system
•    Quality control process for ensuring initial and ongoing data integrity
•    System’s ability to track workers’ compensation lost workdays within the state applicable waiting period
•    System’s ability to track litigation rates and calculate timeframes between the date of loss and first notification date of legal representation. 
•    Organization’s recent innovations and plans for future innovations (i.e. Technology, data analytics, AI claim analysis, medical cost containment, etc.) 
•    County will be provided with a designated it point of contact. 
•    Client claims system data is “real time.” 
•    If not, please provide detail regarding the timing and availability of claims information relative to the timing of the data entry. 
•    Managed cared notes are included in the same system as adjuster notes.