Assigned Claims Processing Agent Services

The Vendor is required to provide assigned claims processing agent services for include:
- Claims processing
• Maintain all financial records necessary or used in the performance of this contract in full compliance with generally accepted accounting principles.
• Will document, and maintain the documentation of, the compensability of all claims and the rationale for their acceptance or denial in accordance with generally accepted claims management procedures.
• Process all claims assigned to it under and in accordance with the requirements of the workers’ compensation laws.
• Process and administer, as provided in this contract, every claim referred to contractor while this contract is in effect.
• Make reasonable efforts to identify and pursue any potential subrogation recoveries from any third party who may be responsible for any paid claim losses incurred with respect to any claim and shall make reasonable efforts to direct such responsible third parties to pay to agency such paid claims losses (such recovered funds, “subrogated funds”).
• Create, maintain and provide updates to agency a current list of any claims
- Audit process
• Agency may conduct periodic audits of claims, claim files, and contractor’s financial records related solely and exclusively to the services provided hereunder, to determine reserves and the appropriateness, under the workers’ compensation laws and applicable generally accepted claims management procedures outlined in oar chapter 436, of amounts chargeable to any claim.
• Claims processing performance audits carried, contractor will make available to agency all and any such financial records and claims documentation at a time and place mutually agreeable to both parties.
• As a result of any audit, agency determines that any amounts have been paid that should not have been paid under the workers’ compensation laws, under applicable generally accepted claims management procedures outlined in oar chapter 436, or under this contract, agency will issue an order under the authority identifying the amounts improperly paid and the reason or reasons that each such payment was improper.