Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7205

Government Authority located in North Carolina; USA based organization looking for expert vendor for workers compensation third party claims administration services.

[*] Budget: Looking for Proposal

[*] Scope of Service:

(1) Vendor needs to provide workers compensation third party claims administration services.
- Providing all services required to supervise, manage, and administer the City’s self-insured workers compensation program.
- Review and investigate all claims and losses reported to the TPA by the City to the extent deemed necessary in the judgment of the TPA, and adjust, settle, contest or otherwise handle all such claims within the authority granted by the City.
- Maintain thorough documentation on all claims, including but not limited to notes of all claim activity, correspondence, Industrial Commission forms and filings, investigatory materials, medical records, rehabilitation and vocational reports, records, invoices, memoranda, and other documents.
- Review all existing workers' compensation claim files and identify files that are closable and continue to perform necessary services to process active claims to conclusion.
- TPA shall assume the complete handling of all prior claims as well as new claims originating from the effective date of the contract.
- TPA shall have a claims Supervisor or Manager to review all notices of injuries received from the City prior to assignment of the claim to an adjuster.
- Initiate contact with injured worker via telephone or email within twenty-four (24) hours of receipt of claim from City.
- The TPA shall provide the injured worker and/or their attorney, responsible customer service. Responsible customer service means to provide the injured worker prompt and accurate information about their claim.
- Provide a customer service representative throughout the duration of the TPA’s contract with the City.
- Assist the City in coordinating all return-to work efforts of the injured employee and notify the City of any changes to the injured employee’s medical status including work restrictions.
- Coordinate medical treatment of all accepted claims by promptly scheduling appointments and authorizing necessary physician referrals and treatments.
- The City must pre-approve all vendors/specialist assignments to claims.
- Customer Service is of the utmost importance when servicing our Claims. The City is very focused on Customer Service with a philosophy to provide quality services in a manner that is courteous, responsible, accessible, and seamless.
- Advise the City when defense attorney assignment is necessary on a claim file. Advice and consent should be justified in written format to the Workers’ Compensation Manager.
- Maintain a litigation management budget for each litigated file and provide litigation status reports for each litigation file on a quarterly basis.
- Timely transfer all claims data and respective file documentation for all open and closed files into the TPA’s claims information system to ensure future City loss runs will contain a complete history of all claim years.
(2) A non-mandatory virtual pre-proposal conference will be held on March 16, 2023.
(3) All questions must be submitted in written no later than March 16, 2023.

[*] Eligibility:

Onshore (USA Organizations Only)

[*] Work Performance:

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

Expiry Date : Thursday, 30 March, 2023

Pre-proposal Conference Date : Thursday, 16 March, 2023

Question Answer Deadline : Thursday, 16 March, 2023

Category : Medical Billing and Coding

Country : USA

State : North Carolina

Cost to Download This RFP Document : $ 5

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