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MB-4573 - USA (Oregon) - Administration of Workers Compensation and Liability Claims - Deadline October 13,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4573

Government Authority located in Oregon; USA based organization looking for expert vendor for administration of workers compensation and liability claims.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide administration of workers compensation and liability claims 
- The District has an overall average of 5000 employees on the payroll including full-time, part-time, temporary, substitute workers and student workers,
- To provide the highest professional level of responsive claims handling including regular, on-going communication with injured employees and employer from inception to disposition of a claim,
- To be certain employees are advised of their benefits in a timely fashion in accordance with the Workers’ Compensation Act,
- To give prompt attention to all claims matters in an attempt to discourage unnecessary litigation,
- To encourage early recovery from injury and early return to light or modified work,
- To identify and aggressively defend fraudulent or accelerated claims,
- The Third-Party Administrator will assign a dedicated claim examiner to handle Salem-Keizer Public Schools claim files. Other, non-dedicated personnel (e.g. file clerks, data entry clerks, etc.) may be used for administrative functions,
- Review all initial claims and make telephone contact with injured employee(s) within 24 business hours,
- Establish contact with the Public School’s Workers’ Compensation Coordinator within 24 business hours of receipt of any time-loss claim or return to light-duty status to discuss details and to formulate a plan of action. Respond with 24 business hours to all requests for information and service,
- Send a letter to injured workers within three business days of knowledge of injury to inform them of their rights and benefits,
- Coordinate all claims decisions with the Public School’s Workers’ Compensation Coordinator prior to notifying injured employees,
- Determine the Compensability of claimed injuries and illnesses in accordance with the State of Workers’ Compensation laws,
- Contact injured employees by telephone on all claim decisions whenever possible,
- Notify Public School’s Workers’ Compensation Coordinator within 3 business days, when any previously closed claim is reopened and provide the rationale for reopening,
- All files will be kept on a current diary system, where all open and active cases are reviewed monthly by the handling claim examiner. At time of review, telephone contact by the claim examiner will be made to the injured employee and provider for updates on injury and claim progress,
- Contact injured employees receiving time loss benefits prior to issuing all time loss payment to confirm benefit is owed,
- Arrange, with the approval of the Workers’ Compensation Coordinator, activity checks, independent medical examinations, investigations, and rehabilitation services when needed to help guide the management of a claim,
- Refer claims requiring legal representation to legal firms designated by Public Schools. The Workers’ Compensation Coordinator will approve the defense counsel assignment based on the merits of the claim,
- Determine eligibility and recommend payment of medical benefits as well as authorize examinations to determine the nature and extent of disability when appropriate,
- Set appropriate reserves and review for adequacy at least every 60 days,
- A detailed case report, for each case, showing all open claims including status, claim number, name, loss description, occurrence date, paid-to-date and outstanding reserves.
(2) All questions must be submitted no later than October 5, 2020.

[C] Eligibility:

Onshore (USA Organization Only);

[D] Work Performance:

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

Expiry Date : Tuesday, 13 October, 2020

Question Answer Deadline : Monday, 5 October, 2020

Category : Medical Billing and Coding

Country : USA

State : Oregon

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