Posted Date : June 17,2021
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-5410
Government Authority located in Nebraska; USA based organization looking for expert vendor for third party administrator services for workers’ compensation claims.
[A] Budget: Looking for Proposals
[B] Scope of Service:
(1) Vendor needs to provide third party administrator services for workers’ compensation claims
- The vendor’s assigned claims adjustor will work with the managed care nurse manager for management of the County’s on-the-job injuries. The County Workers’ Compensation Coordinator will work with the claims adjuster in determining at what point a managed care nurse manager is required. In conjunction with the managed care nurse manager, the claims adjustor(s) will monitor each injury claim with the objective of returning the injured employee to work as soon as medically possible following the injury. If such injured employee is unfit to work in full duty capacity, the claims adjustor will work closely with the injured employee’s supervisor for a limited duty position within the injured employee’s medical restrictions,
- In order to meet this objective, the vendor’ assigned claims adjuster must be completely familiar with the fine details of each injury, and must work directly with the managed care case manager, injured employee and medical providers,
- Initial processing and investigation of claims:
- On-line claim access capability.
- Time guidelines/requirements for setting up claims.
- Investigation of claim, including three-point contact, recorded statements and time guidelines for file assignment.
- Definition of Record Only, Medical Only and Indemnity Claims.
- Determination criteria for compensability.
- Procedure for denied or disputed claims.
- Communication with Excess Workers’ Compensation Carrier as required in the current policy
- Claims and Medical Management:
- Ongoing contact with the injured worker and employer.
- Coordination of medical care, including Return-to-work and Independent Medical Examinations.
- Medical Care, internal programs and all other medical cost containment.
- Subrogation investigation and recovery.
- Section III Required Medicare Reporting,
- Litigation Management and Case Resolution:
- Litigation management and procedures.
- Strategies for resolving cases,
- Financial Impact Practices:
- Fraud investigation
- Reserving procedures
- Recoveries/subrogation
- Reporting Capabilities:
- Provide copy of all forms and reports believed appropriate for the efficient administration of claims, i.e., initial acknowledgement of claim, closure notice, reserve advisory, claim
review format, etc
(2) All the questions must be submitted no later than July 6, 2021
[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.
Budget :
Deadline to Submit Proposals: July 21,2021
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$
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Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-5410
Government Authority located in Nebraska; USA based organization looking for expert vendor for third party administrator services for workers’ compensation claims.
[A] Budget: Looking for Proposals
[B] Scope of Service:
(1) Vendor needs to provide third party administrator services for workers’ compensation claims
- The vendor’s assigned claims adjustor will work with the managed care nurse manager for management of the County’s on-the-job injuries. The County Workers’ Compensation Coordinator will work with the claims adjuster in determining at what point a managed care nurse manager is required. In conjunction with the managed care nurse manager, the claims adjustor(s) will monitor each injury claim with the objective of returning the injured employee to work as soon as medically possible following the injury. If such injured employee is unfit to work in full duty capacity, the claims adjustor will work closely with the injured employee’s supervisor for a limited duty position within the injured employee’s medical restrictions,
- In order to meet this objective, the vendor’ assigned claims adjuster must be completely familiar with the fine details of each injury, and must work directly with the managed care case manager, injured employee and medical providers,
- Initial processing and investigation of claims:
- On-line claim access capability.
- Time guidelines/requirements for setting up claims.
- Investigation of claim, including three-point contact, recorded statements and time guidelines for file assignment.
- Definition of Record Only, Medical Only and Indemnity Claims.
- Determination criteria for compensability.
- Procedure for denied or disputed claims.
- Communication with Excess Workers’ Compensation Carrier as required in the current policy
- Claims and Medical Management:
- Ongoing contact with the injured worker and employer.
- Coordination of medical care, including Return-to-work and Independent Medical Examinations.
- Medical Care, internal programs and all other medical cost containment.
- Subrogation investigation and recovery.
- Section III Required Medicare Reporting,
- Litigation Management and Case Resolution:
- Litigation management and procedures.
- Strategies for resolving cases,
- Financial Impact Practices:
- Fraud investigation
- Reserving procedures
- Recoveries/subrogation
- Reporting Capabilities:
- Provide copy of all forms and reports believed appropriate for the efficient administration of claims, i.e., initial acknowledgement of claim, closure notice, reserve advisory, claim
review format, etc
(2) All the questions must be submitted no later than July 6, 2021
[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.
Budget :
Deadline to Submit Proposals: July 21,2021
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$