Workers Compensation Third Party Administrator Services

Overview

Financial, Legal, HR & Staffing

Sarasota, Florida, United StatesPosted about 2 months agoDeadline: April 3rd, 2026

Fit Score

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SUMMARY

The county is soliciting proposals for a third party administrator to manage workers compensation claims, provide 24-hour reporting, coordinate medical referrals, support return-to-work programs, and assist with claim investigations and recoveries.

KEY REQUIREMENTS

Demonstrate workers' compensation claims administration experience.
Possess a Florida 6-20 Resident All Lines Adjuster License.
Project team experience with Florida public entity employers having at least 2,000 employees within the last 5 years.
Project team experience with Florida public entity employers subject to 'Heart & Lung' presumption for firefighters, law enforcement, and correction officers within the last 5 years.
Project team includes personnel with public sector claims handling knowledge, experienced adjusters of lost time claims management, and experience in adjusting complex claims, including Presumption claims.
Project team experience with Pharmacy Benefit Management.
Project team experience with Pain Management options.
Complete all required forms and information in the Vendor Questionnaire section of OpenGov.
Provide a single-page Letter of Interest summarizing qualifications.
Provide required and preferred licenses and certifications.
Provide resumes of key personnel, including subcontractors.
Provide a narrative describing the Proposer's experience, capabilities, and resources.
Provide a customer list (1-10 customers) for similar services in the last 5 years, including contact information.
Provide a detailed project approach, including proposed strategy, anticipated resources, staffing levels, technology, and equipment.
Define caseload of recommended adjusters and provide average caseload per adjuster.
Provide an outline of a dedicated unit based on historical information.
Provide details regarding any adjuster caseload maximums.
Provide a graphical schedule/timeline indicating major milestones and deliverables.
Provide an organizational chart identifying all key personnel and their roles.
Provide proposed fees using the pricing table in OpenGov.
Provide a copy of the most recent SAS (70) or similar audit report within the last 24 months.
Submit proof of required licenses or certifications upon contract award.
Implement a drug-free workplace program if required for tie-breaking.
Complete and submit a Local & American Business Certification Form for preference consideration.
Maintain Workers' Compensation insurance with $500,000 Employers Liability per accident/disease/employee.
Maintain Commercial General Liability insurance with $1,000,000 per occurrence and $2,000,000 aggregate, naming Sarasota County Government as an additional insured.
Maintain Professional Liability insurance with $1,000,000 per claim/occurrence and in aggregate, with specific requirements for claims-made policies.
Assume complete handling of all new and existing workers' compensation claims for Sarasota County.
Transfer all claims data to Consultant's Risk Management Information System (RMIS) by the commencement date.
Prepare and file all required applications, bonds, documentation, and data with appropriate state agencies.
Prepare, maintain, and file all records and reports as required by legal authorities.
Prepare and follow County-approved service instructions for claims handling.
Provide monthly and annual reports summarizing claims and yearly experience.
Prepare, maintain, and file statistical and other reports as required by the County's excess insurers.
Comply with all Florida rules, regulations, guidelines, procedures, Electronic Data Interchange (EDI), and Medicare Secondary Payer requirements.
Prepare, maintain, and file statistical information for Workers' Compensation Rating Bureaus and Medicare Secondary Payer.
Prepare and distribute all required 1099 forms.
Annually provide Consultant's SOC-1 report and Bridge letter.
Provide procedures for emergency response, including contact information.
Have a business continuity plan for emergencies.
Regularly inform the County of significant regulatory or industry changes impacting the workers' compensation program.
Meet with County staff monthly for administrative items and quarterly for claim reviews.
Provide an annual stewardship meeting with program results and benchmarking.
Reimburse the County for fines, penalties, or assessments due to Consultant's non-compliance.
Provide 24-hour telephonic or internet-based claim reporting and intake capabilities.
Send First Notice of Injury to the State of Florida in a timely manner.
Receive and examine employee injury claims, referring injured workers to appropriate medical services.
Complete 3-point contacts (injured worker, supervisor, medical provider) within 24 hours of claim report.
Comply with all applicable laws and regulations regarding workers' compensation benefits.
Perform necessary investigations to assure claim validity.
Establish and maintain complete claims files on each claim.
Maintain communication with injured workers, supervisors, and medical providers at appropriate intervals.
Assist the County with its Stay at Work program, including light duty positions and claim management.
Properly review, process, and pay claims on a timely basis.
Establish and update claim reserves, obtaining prior approval from the County's Risk Manager for increases exceeding $25,000.
Provide copies of all pertinent medical, legal, and investigative reports.
Prepare and maintain files necessary for legal defense of claims and other litigation.
Attend hearings, depositions, mediations, and other proceedings as necessary.
Provide timely notification of excess insurers.
Pursue all second injury funds, subrogation, and other recovery opportunities.
Consult with the County on the selection of outside professionals (e.g., surveillance, expert witnesses, attorneys).
Assist the County in establishing a zero-balance loss fund account.
Debit from the County's designated account via daily ACH transfers for claims payments.
Provide the County with a monthly list of all checks issued and outstanding checks.
Incur and pay all bank charges.
Cooperate fully with any audit of the County's claim funding account.
Provide all reports required by the State of Florida.
Provide the County access to Consultant's RMIS System with comprehensive, real-time, online electronic claim information and financial/reporting data.
Provide a minimum of five free licenses to access Consultant's RMIS.
Provide the County with data and reports for annual audit and actuarial requirements by October 10th each calendar year.
Provide the County with a daily download to the County's Origami system.
Maintain a dedicated staffing unit, preferably at a claims office within a 100-mile radius of Sarasota County.
Promptly remove and replace staff upon the County's written request due to performance reasons.
Provide continuing services for all claims occurring during the contract period for three months after termination.
Provide the County with electronic files or other data feeds of all claim data upon contract termination.

BUDGET

Estimate

$500,000 – $2,000,000

Issuing Agency

Sarasota County

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DESCRIPTION

The county seeks a qualified vendor to provide comprehensive workers compensation third party administrator (TPA) services. The selected firm will be responsible for consulting with the county on reporting procedures, including offering 24-hour telephonic or internet-based claim reporting and intake capabilities to ensure efficient and timely claim management.

The administrator will receive and review all reports of employee injury claims in accordance with state regulations, ensuring compliance and thorough examination. Responsibilities include referring injured employees to suitable medical providers, conducting necessary investigations to verify claims, and supporting the county's Stay at Work program by creating and managing light duty assignments, with ongoing status reporting. The vendor will also pursue opportunities for second injury fund recoveries, subrogation, and other potential reimbursements. Additional support includes consulting on the selection and referral to external experts, such as surveillance personnel, expert witnesses, and attorneys, as needed for claim investigation, adjustment, and defense.

Source attribution

This Settle analysis is based on the issuing organization’s public RFP listing.