Third Party Administration for Workers’ Compensation Claims and Managed Care Services

A California public agency is seeking a qualified vendor to provide third-party administration for workers’ compensation claims and managed care services in support of its self-insured workers’ compensation program. The selected contractor will be responsible for the investigation, adjustment, processing, supervision, and resolution of workers’ compensation claims, as well as reviewing and processing industrial injury cases in accordance with state reporting and notification requirements.

Services include determining compensability of injuries and illnesses under state workers’ compensation laws, supporting fraud, waste, and abuse prevention, and ensuring prompt, effective, and cost-appropriate medical treatment for injured workers to promote safe and early return to work. The contractor will also manage and maintain a medical provider network, recommend physicians and specialists as needed, maintain close coordination with treating providers, and assist injured employees with permanent disability ratings, qualified medical examiner and agreed medical examiner processes, and claim settlements.

Additional responsibilities include providing a comprehensive medical bill auditing and cost-containment program using both automated bill review tools and manual auditor review for complex or high-value bills. The scope also includes utilization review and medical case management services. A pre-bid meeting is scheduled for July 20, 2026, questions are due by July 27, 2026, and the anticipated contract term is three years.