MB-3284 - USA (New Jersey) - Third Party Claims Administration, Loss Control and Managed Care Services - Deadline August 6,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3284

Government Authority located in New Jersey; USA based organization looking for expert vendor for third party claims administration, loss control and managed care services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

Vendor needs to provide third party claims administration, loss control and managed care services
- Supervise the County’s obligation to employees who sustain bodily injury or neurological injury and occupational illnesses in the County service or employ,
- Provide three-point contact on all claims received within 24 hours of receipt,
- Investigate, handle, and adjust to conclusion all claims with a date of loss occurring during the term of the contract,
- Compile and file all notices and reports required under workers’ compensation law including electronic data interchange reporting of first report of injury and subsequent reports of injury claims data to the compensation rating and inspection bureau if so required,
- Provide for the medical care, medical supervision and administration necessary for the disposition of workers’ compensation claims filed by the employees, including field investigation and subrogation activity,
- Provide and maintain an electronic database of all claims filed; including but not limited to file notes, appointments and financial transactions,
- Prepare and submit a monthly listing of all checks issued during the month, the listing shall contain the following information: check number, transaction date, amount, payee, and name of employee and claim number,
- Coordinate claim proceedings with excess insurer,
- Investigate, handle, and adjust to conclusion all claims with a date of loss occurring during the term of the contract,
- Coordinate claim proceedings with excess insurer and law department,
- Any and all other activities normally associated with auto and general liability third party claims administration,
- Pre-certification of every hospital admission and outpatient surgery,
- Concurrent and utilization review of all medical services,
- Network of contracted physicians with workers’ compensation experience, hospitals, medical professionals, healthcare facilities providing quality care at negotiated discounted fees located in the county’s geographic area,
- Review and audit of medical bills to assure compliance with contracted fees as well as accuracy and appropriateness of all bills,
- Disability management designed to return employees to work in a timely manner when medically able,
- Maintain a strong relationship with any claims administrator retained by the county to insure proper claims coordination between managed care provider and claims administrator.

[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, 6 August, 2019

Category : Medical Billing and Coding

Country : USA

State : New Jersey

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