Third Party Workers Compensation Claims Administration Services
Location:
California, United States
Posted on:
Deadline:
Summary:
The City of California is requesting proposals for one-year third-party administration of workers compensation claims, including claims handling, employee communications, and fraud investigation.
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The City of California is seeking a vendor to provide third party workers compensation claims administration services. The selected provider will administer workers’ compensation benefits in full compliance with labor codes, ensuring timely and responsive contact with injured employees and establishing claim files within twenty-four hours of the employer’s first injury report. Claim files must remain accessible to the city during regular business hours and issues identified by the city must be resolved promptly, which may involve reassigning claims examiner staff as necessary.
Key responsibilities will include making and documenting compensability determinations, guiding and informing city employees regarding workers’ compensation benefits, and responding to city staff inquiries within twenty-four hours—addressing critical issues on the same business day. The administrator will monitor medical treatment programs to ensure appropriate care while also preventing excessive or unnecessary treatments. Additionally, the provider will be responsible for establishing and adjusting claim reserves throughout each claim’s lifecycle, identifying and pursuing potential system abuse or fraud, and investigating questionable claims with the city's consent, including facilitating independent outside investigations.
The contract will be for a one-year period. All questions regarding this RFP must be submitted no later than March 30, 2026.
Best-fit vendors:
• Experienced third-party administrator specializing in workers compensation claims
• Proven track record serving municipal or public sector clients
• Staffed with licensed claims examiners and specialists
• Demonstrated ability to comply with California labor codes
• Capacity to provide timely communication and responsive service
