Third Party Claims Administrator Services

The Vendor is required to provide third party claims administrator (TPA) to support a self-insured on-the-job injury program.
- An on-the-job injury reporting system that would interface with the claim system, as well as comply with OSHA reporting standards.
- Requirement:
• Contract with a qualified, experienced, and professional service provider to support a self-insured on-the-job injury program.
• Establish a service team responsible for services necessary to process and pay on-the-job injury claims received by county risk management.
• Must be able to assume a full-scale implementation date of July 1, 2026, or within 30 days of RFP award, whichever is most feasible.
• TPA shall lead and coordinate efforts with the risk management department to transfer of any historical claim data presented within current county provider systems into the awarded TPA’s platform.
• Utilize an information system with on-line access available and allow access to county risk management, key stakeholders, and related designees.
• The on-line system/platform provided by the TPA shall include customizable options and shall capture a record of key activities as each case develops.
• Such system items shall include, but are not limited to: notes indicating that a particular letter was received or sent by the adjuster; that a meeting was held on a particular date; or the reason that a reserve was changed.
• Ensure that key claim information is stored in a secure and readable format.
• TPA provided information system must have statistical reporting capabilities that will enable the generation of ad hoc customized reports showing statistical data (amounts reserved, paid, etc.) for individual claims or summarized groups of claims selected by the user.