Worker's Compensation Claims Administration Services

The Vendor is required to provide collaborative claims administration partner committed to proactive claims management, timely communication, employee-centered service, cost containment, early return-to-work strategies, fraud prevention, and reduction of litigation exposure.
- Claims management approach that balances fiscal responsibility with fair and responsive treatment of injured employees and supports productive labor-management relationships.
- Requirement:
• Review each claim and loss report submitted by the village to determine compensability or liability.
• Perform necessary and customary administrative and clerical work in connection with each qualified claim or loss, including the preparation of checks or vouchers, releases, agreements and other documents needed to finalize a claim.
• Receive medical bills related to workers’ compensation claims.
• Forward bills to the bill review and PPO vendor for review and discounting.
• Identify claims with potential for subrogation and pursue subrogation possibilities on behalf of the village where and when applicable, or as directed by the village.
• Excess carriers of all claims and or losses, which may exceed the village’s retention, including qualified claim(s) and or loss specific reporting requirements of excess insurance carriers and, if requested, provide information on the status of those claims or losses.
• Designated village employees with inquiry access to the vendor’s proprietary claims system.
• Assist in the management of claims to insure timely return to work including work hardening and return-to-work programs, and where appropriate the coordination of vocational rehabilitation services and identification of alternative jobs within and outside the village.
• Identify and pursue third party payers.
• Provide assistance to the legal counsel as needed for settlement of such claims.
• Conduct and administer subrogation process.
• Advanced analytics and reporting capabilities, including but not limited to:
o Interactive or web-based dashboard reporting;
o Claim trend analysis by department, injury type, and cause;
o Lag-time reporting from injury occurrence to reporting;
o Litigation tracking and legal spend analysis;
o Reserve and loss forecasting reports;
o Osha and safety trend reporting;
o Return-to-work metrics and lost-time analysis;
o Custom reporting capabilities upon village request; and
o Data exports compatible with actuarial analysis and excess insurance reporting requirements.