Description
Montebello Unified School District (MUSD) is seeking a qualified third‑party administrator (TPA) to manage all workers’‑compensation claims for its K‑12 employees across the district. The vendor will be responsible for end‑to‑end claims processing, payments, litigation support, medical bill review, fraud investigation, real‑time reporting, and secure data handling, while complying with California statutes and district‑specific policies.
• Administer claim intake, investigation, adjustment, payment of indemnity, medical and expense benefits, and maintain accurate reserves.
• Provide comprehensive reporting (monthly loss runs, quarterly summaries, annual stewardship, CMS/MMSEA filings) via a secure, HIPAA‑compliant claims management platform.
• Manage litigation coordination, sub‑rogation efforts, and a Special Investigative Unit (SIU) for fraud detection; include call‑center support and managed‑care services.
• Deliver a transition plan for existing open/closed claims, ensure data portability, and meet strict insurance, indemnification, and confidentiality requirements.
• Submit an all‑inclusive cost proposal (not‑to‑exceed) with detailed fee breakdowns and required certifications (e.g., insurance certificates, background‑check compliance, EO certification).