WORKERS’ COMPENSATION THIRD PARTY ADMINISTRATION AND MANAGED CARE COST CONTAINMENT SERVICES RFP

The County of San Mateo is seeking a Third-Party Administrator to provide Workers' Compensation Claims Management and Managed-Care Cost Containment Services for its self-insured Workers' Compensation Program. The selected administrator will be responsible for managing all new and existing claims, including indemnity, medical, and first aid claims. The administrator will also be required to provide group education for County staff, develop procedures and forms for claim management, and maintain accurate claims reserves. The contract will have a term of three years, with an option to extend for an additional two years. Key responsibilities of the selected administrator will include: • Developing procedures and forms for claim management • Providing group education for County staff • Maintaining accurate claims reserves • Managing all new and existing claims • Coordinating with medical practitioners to monitor injured workers' treatment process • Providing utilization review approval for all consults, diagnostics, physical therapy, pharmaceuticals, and other medical services • Conducting thorough investigations of claims to prevent improper billing practices • Maintaining a Special Investigative Unit program to aggressively pursue fraud cases • Providing monthly reports, including daily check registers, loss reports, and other reports as required • Maintaining an effective claim electronic data security system • Ensuring compliance with all applicable laws, rules, and regulations governing the administration of self-insurance. The County is looking for a qualified administrator with extensive experience in providing Workers' Compensation Third Party Administration services and Managed Care services. The selected administrator will be required to have a knowledgeable background and qualifications in the provision of these services, as well as holding all licensing required to provide workers' compensation claim services.