Workers Compensation Claims Management Services

The Vendor is required to provide services that include, but not limited to, claim administration, claim management, claim investigations, and adjustment services usual and necessary in connection with authority self-insured workers’ compensation program.
- Requirements
•    Timely and appropriate care for injured workers through in-network provider and emergency care (any facility). 
•    This can also include an out-of-network provider that has been approved to provide treatment
•    Coordination between in-network providers, approved out-of-network provider(s), injured worker, injured worker’s management, and identified contacts from authority safety and human resources departments 
•    Services for authority to report claims 365/24/7 and seek care through in-network providers, including emergency care without prior approval 
•    Investigation into all reported claims and provide workers’ compensation claims processing services
•    Availability during business hours, Monday through Friday (7am-6pm cst.), to support ongoing communication with authority key personnel
•    365/24/7 online system availability to support authority business needs, with accurate claim information and case notes
•    Coordination of medical bill review and medical cost control 
•    Subrogation services, if necessary
•    Personnel that maintain all licenses and credentials required for their respective positions
- Claim administration 
•    Claims adjuster shall evaluate the urgency of the injury and within twenty-four (24) hours contact authority about any questions on the information provided in the first report of injury (FROI) 
•    Input case notes, record all interactions, decisions, and claim progress with accuracy in the online system within twenty-four (24) hours
•    The claims adjuster will work collaboratively with the injured worker, authority and in-network provider(s) and approved out-of-network provider(s) 
•    Initiate pre-authorization of care
•    Expedited notice of first report of injury (FROI) within 24 hours to authority once entered in supplier’s system
•    Provide accurate estimations for cost of each workers’ compensation claim, track all payments and financial activity, and report the information until the claim is fully resolved and closed
•    Be available during normal business hours to evaluate urgency of situations and provide and coordinate initial claims handling support services
•    Be responsible for client correspondence, collection of supporting documentation associated with the claim, submit and collect payments on authority behalf, client negotiation within standard approved guidelines, negotiation and correspondence with claimant’s insurance company, quarterly, annual and ad hoc claims reporting and follow-up assessments if necessary
•    Should the claims adjuster determine that a nurse case manager is required, one will be assigned. 
•    Authority can also request that a nurse case manager be assigned
•    Should authority request that the nurse case manager assigned to the claim be replaced, the change will occur within one (1) week of authority request.

- Intent to Bid Due Date: May 22, 2026