Workers Compensation Claims Examiner Services

The issuing association is seeking workers compensation claims examiner services to support its division or program staff and interact with local governments and authorities. The selected provider must initiate initial investigations for newly assigned insurance claims, confirm coverage, and contact members, representatives, claimants, attorneys, or injured employees to obtain and provide information. The scope of work requires initiating compensability and liability determinations through statements, recorded statements, and on-site investigations. The agency requires the examiner to set initial reserves, perform timely reserve evaluations, review and approve bills, and review medical or rehabilitation notes. The provider must also review and sign off on daily check sheets and prepare reports for excess carriers when losses exceed one-half of the retention level. Additional duties include establishing and maintaining claim diary requirements with documented action plans and responding to inquiries from members, injured employees, vendors, case managers, legal representatives, and medical providers. Bidders must perform all work onsite and must be located onshore within the United States. The association accepts digital responses submitted via email or online. The agency is looking for proposals to determine the budget, and the original posting notes that this opportunity is formatted as a job posting rather than a traditional request for proposals.