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MB-6510 - USA (California) - Third Party Workers Compensation Claims Administration - Deadline July 6,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6510

Government Authority located in California; Canada based organization looking for expert vendor for third party workers compensation claims administration.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide third party workers compensation claims administration.
- An account manager for this program. This individual will play an essential role in the successful administration of this program and should have authority and overall responsibility for the following key components of the program:
• Service agreement administration and management of TPA staffing on the City’s account
• Trouble shooting and providing effective solutions to resolve issues or problems with the service agreement and claims management services.
• Identify key outcome-based measurements that are tracked and deliver program improvements and cost reduction results.
• Monitor claim trends and audit claim handling procedures to ensure a high level of customer service and best in class claim service deliverables.
• Coordinate regular claim reviews for the City, with participation of the appropriate dedicated claim staff, City representatives and as needed; defense attorneys.
• Assist in coordination of an annual stewardship meeting to present/discuss program changes, performance metrics, benchmarking and claim trending/loss analysis reports.
• Provide or facilitate any custom data download, report requests of the City or its agents
- Key Claims Administration Requirements
• Fraud Control - Gardena requires the claims administrator to aggressively investigate and control fraud and report all claims meeting the State Fraud reporting guidelines.
• Claim Reviews - Quarterly claim reviews on-site at the City is required. The TPA is expected to send dedicated claim staff to attend claim reviews.
• Loss Reporting and Claim System Access - The City requires, on a monthly basis, basic loss reports detailing claim frequency, open inventory, paid and incurred costs.
- Claim Staffing expectations and Claim Handling Philosophies
• The City desires a dedicated senior claim examiner for its program in order to foster a partnership approach to its workers’ compensation program.
• Staffing - the City’s objective is to secure a proactive claims management service to ensure that its claims are managed actively and resolved promptly.
- Risk Management Information System (RMIS)
• claim system with access to view claim adjuster and supervisor notes, generate loss runs or other pre-scheduled or adhoc loss management and claim reports.
• Provide RMIS technical support for questions, problems or development of customized reporting.
• Quality control program to ensure data integrity and claimant confidentiality. Any RMIS problems will be resolved within 24 hours or less. Please provide a list of occupation codes, injury codes and payment type codes.
• Image system to scan all documents received pertaining to the case.
• Describe system security protocols to protect client and employee data, including but not limited to; security audits, protected by intrusion prevention and intrusion detection systems, communications of any claimant’s personal information or personal health information is protected
(2) All the questions must be submitted no later than June 17, 2022
(3) The contract period will be for three years.

[C] Eligibility:

- Onshore (USA ONLY);

[D] Work Performance:

Performance of the work will be Offsite.

Expiry Date : Wednesday, 6 July, 2022

Question Answer Deadline : Friday, 17 June, 2022

Category : Medical Billing and Coding, Staffing Services

Country : USA

State : California

Cost to Download This RFP Document : $ 5

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