Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-7851

Government Authority located in Colorado; USA based organization looking for expert vendor for third party claims administrator services.

[*] Budget: Looking for Proposals

[*] Scope of Service:

(1) Vendor needs to provide third party claims administrator services.
- Providers or Professionals for a third-party claims administrator to provide self-insured workers' compensation, property, and liability claims services.
- Insurance Consulting
- Claims Processing Services
- Insurance and Risk Management Services
- Claim data for the last five (5) years plus year-to-date for 2023 based on claim type. Of the auto liability and general liability claims listed
- Service Provider/Professional will be responsible for either issuing a check for payment or a denial letter on these files.
- Create files and reserve within two (2) working days from receipt of the initial report.
- Establish diaries so each claim is reviewed at least every thirty (30) days or more frequently where needed. Document confirmation of review
- Pay bills promptly per City instructions
- Audit medical bills and repair bills for causal relationship and reasonableness of charges.
- Report all indemnity claims to the Index Bureau upon file creation and retain a copy with the file
- Provide copies of all written correspondence from the administrator to doctors, claimants, attorneys, rehabilitation counselors, investigators and state agencies.
- Clearly document all file activity, including telephone conversations or personal meetings, and diary reviews to reflect the date, individuals involved, content of discussion and plan of action electronically and provide authorized City employee access
- Establish specific direction on the investigation and handling of all indemnity cases within three (3) working days from receipt of the initial report, and clearly evidenced in the file
- Establish claim reserves and provide a continual review and update of reserves to reflect changes
- Maintain a file for each claim submitted with the file available for review by the City at any reasonable time
- Consult and cooperate with employees as may be necessary to achieve a successful claims management program
- Claims Investigation and Management
- Conduct the necessary investigation of each claim using competent and qualified personnel, including such investigation as is necessary to determine liability.
- Contact the department and designated employee for City's statement before determining liability
- Monitor treatment program for injured employees to assure that treatment is related to the compensable injury or illness.
- Consult with City Risk Management staff prior to authorizing medical procedures.
- Maintain a close liaison with treating physicians to assure that employees receive proper care and to avoid over treatment situations
- Determine eligibility for and authorize payment of Temporary Disability compensation in accordance with medical advice, rehabilitation efforts and State law.
- Schedule independent medical examinations with qualified physicians in cases where treatment, length of disability or extent of permanent disability assigned is in question
- Investigate whether subrogation can be ruled out or pursued in all cases which may involve third party negligence
- Attend monthly meetings with City designated physician
- Claim Analysis and Report
(2) All question must be submitted no later than November 10, 2023.

[*] Eligibility:

- Onshore (USA organization Only);

[*] Work Performance:

- Performance of the work will be Offsite.

Expiry Date : Wednesday, 22 November, 2023

Question Answer Deadline : Friday, 10 November, 2023

Category : Medical Billing and Coding

Country : USA

State : Colorado

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