Workers Compensation Claims Examiner Services

The association is seeking workers compensation claims examiner services to support division or program staff and interact with local governments and authorities. The selected provider must demonstrate a general understanding of the association's programs and services while delivering customer support that reflects positively on the entire organization. The scope of work requires initiating initial investigations for newly assigned insurance claims, confirming coverage, and contacting members, representatives, non-represented claimants, attorneys, or injured employees to obtain and provide information. The service provider must determine compensability and liability by taking recorded statements and conducting on-site investigations. Responsibilities also include setting initial reserves, performing timely reserve evaluations, reviewing and approving bills, reviewing medical or rehabilitation notes, and signing off on daily check sheets. Additionally, the provider must prepare and submit reports to excess carriers when losses exceed one-half of the retention level, and maintain proper claim diary requirements with documented action plans. The provider must receive and respond to inquiries from members, injured employees, vendors, case managers, legal representatives, and medical providers. Eligible bidders must be located onshore within the United States, and the performance of the work must be conducted onsite. Bidders may submit responses digitally via email or online, and the association is currently looking for proposals to determine the budget.