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MB-3530 - USA (Hawaii) - Claims Handling Services for Workers Compensation Claims - Deadline December 2,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3530

Government Authority located in Hawaii; USA based organization looking for expert vendor for claims handling services for workers compensation claims.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide claims handling services for workers compensation claims to the
expedient investigation and administration of claims,
- Upon receipt of a new loss report, a claim must be set up in the TPA system within 24
hours capturing relevant data on the loss, to include claimant information, description of
accident/injury, driver, time of loss, location code, etc,
- Assign and investigate all new claims for liability in a prompt and timely fashion,
- Assign claims based on the level of complexity to appropriate claims handler to ensure
aggressive but fair claims handling,
- TPA shall manage all claims presented to them according to the professional standards
of the firm (Best Practices) as well as the County’s account instructions,
- All claim activity will be timely documented in the claim notes,
- All open files will carry an open diary by an adjuster and the supervisor, each open file
will reflect supervisor involvement from claim assignment to conclusion,
- Explain when recorded statements would be obtained from claimants,
- If a denial of a claim is recommended, the TPA will provide a written basis for the denial
and a strategic plan for the defenses of the claim and outline exposures.
- The county’s deputy corporation counsel handles disability compensation division Hearings, the assigned adjuster will assist and participate in a hearing,
-Recommend medical management when appropriate to facilitate and cost contain medical treatment,
- Develop and maintain adequate claim reserves, ensure files contain reserve rationale,
and complete an ongoing review of reserves on all open claims, as warranted.
Describe your philosophy and procedures for setting and monitoring claim reserves,
- Claim documentation must be electronically accessible on request by the County,
- To discuss claims that involve liability issues, ongoing litigation, complex medical issues, ongoing
temporary disability benefits and other claims identified
- Investigate 3rd party (subrogation) liability claims and facilitate recovery of any amounts due to the County.
(2) All the questions must be submitted no later than November 25, 2019.
(3) A contract term will be for one year.

[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 : Monday, 2 December, 2019

Question Answer Deadline : Monday, 25 November, 2019

Category : Medical Billing and Coding

Country : USA

State : Hawaii

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