Third Party Administration Workers’ Compensation Claims and Managed Care Services

The agency is seeking a vendor to provide third-party administration for its workers' compensation claims and managed care services. The objective is to ensure prompt, effective, and cost-appropriate medical treatment for injured workers, facilitating their safe and early return to work. This includes supervising and administering the self-insured workers' compensation program. The scope of work covers the investigation, adjustment, processing, supervision, and resolution of workers' compensation claims. The vendor will review and process all industrial injury cases according to state agency requirements for reporting and notification. The vendor must determine the compensability of injuries and illnesses under state workers' compensation laws, with a focus on preventing fraud, waste, and abuse. The vendor will manage a medical provider network (MPN) and recommend physicians for initial treatment and specialists for long-term or specialized care. This includes maintaining close liaison with treating physicians. The vendor will also provide guidance to injured employees regarding permanent disability ratings, qualified medical examiner processes, and claim settlements. A comprehensive medical bill auditing and cost-containment program is required, utilizing both automated software and manual review for complex bills. Utilization review and medical case management services are also part of the requested services. The performance of this work will be offsite. Eligibility is restricted to onshore organizations within the USA. All questions regarding this opportunity must be submitted no later than July 27, 2026. A pre-bid meeting is scheduled for July 20, 2026. The anticipated contract period is for three years. The agency is looking for proposals and responses can be submitted digitally via email or online.