MB-2918 - USA (California) - Self-Insured Workers Compensation Third Party Claims Administrator Services - Deadline March 26,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-2918

Government Authority located in California; USA based organization looking for expert vendor for self-insured workers compensation third party claims administrator services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide self-insured workers compensation third party claims administrator services for the city’s self-insured workers’ compensation program, primary importance on a quality benefits delivery program that will manage and direct workers’ compensation claims, in a manner that will ensure consistently good employee relations, reductions in litigation; containment of costs; and control of allocated expenses.
- Assignments to outside providers, including medical exams, investigators, rehabilitation and therapy services, and defense counsel are to be controlled by the claims staff with approval from the human resources director to assure delivery of a quality, results oriented product by individuals knowledgeable of claims administration.
- Claims administration services which include entering claim information on a log and establishing a claim file upon receipt of an injury report, setting and updating reserves requirements, coordinating investigations, determining compensability of claims, preparing and issuing benefit notices and pamphlets, arranging for medical treatment from medical practitioners and specialists, initiating and maintaining contact with employees and applicant attorneys as required, monitoring disability status by reviewing medical reports and contacting medical practitioners for updates, auditing and paying medical bills, paying mileage reimbursement to employees, arranging medical examinations in conformance with state law to determine status of employees’ medical condition up to and including permanent and stationary and permanent disability, paying total temporary disability and permanent disability compensation in accordance with the law, arranging representation for the city, whenever the need arises, with attorneys selected by the human resources director, monitoring attorneys and assisting them in preparing cases, auditing in paying legal expenses, arranging for vocational rehabilitation services when appropriate, monitoring voucher system, auditing and paying voucher system expenses, attending all hearings that are required by law, preparing and issuing permanent disability compensation notices, pursuing subrogation when there is a viable third party, timely notification to the human resources director and the city’s excess insurance carriers of all claims which exceed or may exceed the city’s self-insurance retention, maintaining timely communication between the city and its excess insurance carriers on matters affecting the handling of such claims and arranging for reimbursement to the city for losses in excess of its self-insurance limits, communication regarding all claims to the index bureau, report suspected fraud cases to the insurance crime prevention institute and the state department of insurance, bureau of fraudulent claims, close claim files when appropriate to do so and notify the City of such closure.
(2) All question must be submitted no later than March 19, 2019.
(3) Contract period will be two years.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location

Expiry Date : Tuesday, 26 March, 2019

Question Answer Deadline : Tuesday, 19 March, 2019

Category : Medical Billing and Coding

Country : USA

State : California

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