What the buyer needs
AI summaryThe City of Modesto seeks a qualified vendor to provide workers' compensation third party administrator services for approximately 1,700 full-time and part-time employees. The required scope includes injury reporting, claims and medical management, nurse case management, bill review, litigation and SIU investigation management, return-to-work program administration, and staff training. Onshore USA organizations may bid, and the awarded contractor must maintain a City of Modesto business license. Proposers must submit questions by November 24, 2026, and submit proposals electronically through the City's OpenGov Procurement portal prior to 11:00 am on December 15, 2026. A selection committee will evaluate proposals on a 100-point scale, where price is one factor, and the City may award one or more agreements. The contract term is two years with three one-year extension options, and pricing must remain firm for the first two years.
Scope of work
- Claims administration and management for self-insured workers' compensation program
- Bill review services for all invoices received
- Utilization review services and medical treatment evaluation
- Nurse case management and medical administration
- Return-to-work program administration
- Litigation and investigation management
- Trust account payment processing and reconciliation
- Monthly, quarterly, and annual loss and injury reporting
Minimum qualifications
- Licensed with the California Department of Industrial Relations, Self-Insurance Plans (SIP)
- Minimum five (5) years' experience working with public agencies with public safety employees
- Claims Manager, Supervisor, and Adjusters state-certified as Self-Insurance Administrators
- Claims Supervisor with minimum five (5) years' California public agency claims experience
- Senior Claims Adjusters with minimum five (5) years' workers' compensation claims experience
- Medical-only Claims Adjusters with minimum three (3) years' workers' compensation claims experience
- City of Modesto Business/Delivery license required prior to beginning service
Documents to include with your response
- Pricing Schedule
- Proposer Exceptions, Clarifications, Amendments (if applicable)
- Proposer Customer References
- Financial Interest Disclosure
- Proposer Company History Statement
- Proposer Financial Statements
- Addenda Acknowledgement
- Proposer Experience and Certifications
- Programs
- Third-Party Administrator Questionnaire
How to submit
- Method
- Electronic via the City's OpenGov Procurement portal
- Instructions
- Submit electronically through the OpenGov Procurement portal at https://procurement.opengov.com/portal/modestogov/projects/294833. No hard copy proposals or other formats will be accepted.
