Claims Adjusting Services

The Vendor is required to provide adjust claims in full compliance with applicable federal, state and local laws, rules, and regulations governing the administration of self-insurance.
- Requirements
• Provide dedicated appropriate staffing to provide services pursuant to this solicitation.
• Ensure the assigned adjuster(s) has the capacity, including the skills and time required, to fully address claims the city sends to the contractor for investigation and adjustment.
• Adjust staffing levels, as needed, to effectively and consistently facilitate and timely manage all claim volume.
• Assigned staff must have a minimum of 3 years of experience handling automobile liability and general liability claims, including those with bodily injury and subrogation, as well as demonstrated experience with sovereign immunity and claims.
• Also disclose any services that will be subject to subcontracting.
• Provide loss investigation and claims adjustment services, pursue subrogation claims, and evaluate repair estimates involving claims assigned to the contractor.
• Claims investigations should be conducted in a timely and efficient manner and in accordance with industry standards.
• All adjuster activity, including receipt of emails, reports, photos, and other documents related to claims investigation shall be documented within the “notes” section of the claim file.
• Status reports shall be provided at 30-day intervals, including an initial report due within 30 days of opening a claim, and provide a thorough summary of the claim investigation and any pending or required actions to bring the claim to closure
• Maintain a separate electronic file for each reported claim, to include information deemed necessary by the office to ensure a thoroughly investigated case in the event of litigation involving a claim.
• Claim files will be made available to the city for review and inspection at no cost upon request.
• Also maintain an electronic claims management information system for management of individual claims, which shall include the ability to store all documents and photos related to a claim, as well as contain dated and timestamped entry logs for all file activity.
• The system should be capable of integration with other software programs and databases used by the city in a manner accessible to city personnel and approved by the city’s department of information technology
• Certain staff from office must have user access to this system for file entry as well as monitoring claim activity.
• Training shall be provided on the use of the system by the contractor.
• System must also be capable of producing monthly and on- going ad-hoc reports of the city’s claims activity that will enable the city to meet state agency reporting requirements as well as facilitate analysis of claims data for actuarial reporting and projections, operational and cost allocation, and budget management issues.
• This data shall be made accessible to the city upon request.
• Recommend and set claims reserves for each claim and review and update reserves monthly or as needed based on information received during the investigation.
• Coordinate with the city’s workers’ compensation claims staff and third-party administrator in establishing liens and protecting city subrogation interests with an assigned liability claim involves injury to city employees.
• Maintain a state presence that includes a claims handling office fully staffed to meet the requirements of the city’s adjustment needs.
• Able to respond to the scene of the accident to investigate on a 24-hour basis.
• As needed, serve as a witness on behalf of the city during litigation and other legal processes for the adjudication of various liability claims.