MB-3428 - USA (New Jersey) - Third-Party Administration Services for Self-Insured Workers’ Compensation and General Liability Claim Services - Deadline September 26,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3428

Government Authority located in New Jersey; USA based organization looking for expert vendor for third-party administration services for self-insured workers’ compensation and general liability claim services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide third-party administration services for self-insured workers’ compensation and general liability claim services
- Maintain or establish a local office with account manager, dedicated workers’ compensation
and liability supervisor, and sufficient dedicated claims staff to handle the county’s accounts,
- Provide effective, courteous and cost-efficient claim handling including but not limited to, all
loss adjustments, investigations and settlements (within the approval authority) of reported
claims, a claim shall include any of the following:
- Workers’ compensation – lost time and medical only; general liability; automobile
liability; public officials; police professional; errors and omissions,
- Maintain a comprehensive file for each reported claim or loss and preserve such records as
required by state statutes and/or regulations. such records shall be available for review by
ocean county and/or its designated representative at any reasonable time,
- Administer all programs in full compliance with all laws, rules and regulations governing workers’ compensation, general liability and self-insurance,
- Conduct an investigation of each reported claim or loss as necessary to properly administer the
- Recommend claim reserves and provide continuous review and updating of these reserves, promptly close claim files when appropriate to do so,
- Review all sizable and unusual claims by candidate’s internal audit staff at no additional cost to
the county and provide results of such review,
- Notify the county’s excess insurance carriers, in accordance with reporting requirements
established by the carrier, of all claims which exceed or may exceed the county’s self-insured
retention, maintaining liaison between the county and its excess carrier on matters affecting
the handling of such claims and arranging for reimbursement to the county of losses in excess
of its self-insured retention,
- Prepare and provide claim reports as required by excess insurance carriers,
- Investigate all claims for potential third-party recovery, pursue subrogation when there is a viable third-party, and protect the lien rights of the county,
- Immediately furnish the county with a written report of the existence of any hazardous condition that becomes evident during the course of an investigation,
- Maintain a fraud protection program, including a comprehensive plan to detect, investigate and
resolve actual and potential fraud and abuse, and implement procedures to prevent fraud,
abuse, and similar improprieties, aggressively defend fraudulent claims,
- Perform bill review on all billings related to the administration of the County’s workers’ compensation and general liability programs,
- Provide other services on an as-needed and as-requested basis at an agreed upon cost,
- Monitor treatment programs recommended for employees by physicians or specialists by
reviewing all reports prepared by treating physicians and maintaining appropriate contact with
treating physicians,
- Conduct three-point contact for each reported claim with the following:
- Injured worker, risk management, physician,
- Investigate, evaluate, process, manage and resolve bodily injury, personal injury, property
damage claims and potential claims for monetary damages asserted by third parties against the
County, its officers, departments, agents, commissions, or employees for which they are
alleged to be legally responsible.
(2) A contract term will be for three 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 : Thursday, 26 September, 2019

Category : Medical Billing and Coding

Country : USA

State : New Jersey

RFP Expired

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