Description
The State of California, through its Department of Social Services (CDSS) and in partnership with the Department of General Services (DGS) Office of Risk and Insurance Management (ORIM), is seeking a qualified Third‑Party Administrator (TPA) to manage workers’ compensation claims for four major public‑assistance programs (IHSS/WPCS, CalWORKs, CalFresh E&T, and CalFresh SNAP). The contractor will be responsible for end‑to‑end claim administration, data migration from the incumbent TPA, daily electronic payment processing with the State Controller’s Office, and comprehensive reporting, while complying with stringent security, privacy, and statutory requirements. The contract is a three‑year base award with an optional three‑year extension.
• Provide statewide workers’ compensation claims administration, managed‑care, and cost‑containment services for IHSS/WPCS, CalWORKs, and CalFresh programs.
• Migrate all open and closed claim data from the incumbent TPA’s systems to a paper‑less, web‑based claims/risk‑management platform by 1 Dec 2027.
• Deliver daily electronic claim‑payment processing, sub‑rogation, litigation management, nurse case management, and extensive monthly/quarterly reporting while meeting CDSS security and confidentiality standards.
• Maintain required staffing levels, California office presence, and all mandated insurance and certification (including DVBE participation and self‑insurance administrator status).
• Contract term: 3 years (Dec 1 2027 – Nov 30 2030) with one optional 3‑year extension; award expected Jan 2027.