TPA Workers' Compensation Services

Third-Party Administrator (TPA) shall provide comprehensive administration, management, consulting, and support services for SORTA's self-insured Workers' Compensation program.
- Claim administration services from claim intake through closure, including:
• Administration and management of all self-insured Workers' Compensation claims.
• Claims review, processing, filing, and documentation management.
• Determination of claim compensability in accordance with applicable Ohio Workers' Compensation laws.
• Benefits administration, including calculation and payment authorization of indemnity and medical benefits.
• Claim reserve establishment, monitoring, and adjustment.
• Maintenance of complete claim files and records.
• Ongoing claims consulting and strategic recommendations.
- Medical Management and Return-to-Work Services including:
• Coordination of medical treatment and provider services.
• Medical bill review and auditing.
• Case management services.
• Independent Medical Examination (IME) coordination.
• Managed care provider coordination.
• Rehabilitation and vocational services.
• Return-to-work and transitional duty program support.
• Medical control and injury management program development
- Cost Containment and Financial Management including:
• Cost containment and claim cost reduction initiatives.
• Subrogation identification and recovery.
• Cost allocation review and correction.
• Claims payment administration.
• Financial controls and account management.
• Claims reserve analysis and forecasting.
• Assessment and payroll audit support.
• Excess insurance reporting and coordination.