San Mateo Opengov #216886

San Mateo County Workers’ Compensation Claims Management and Managed Care Services RFP

San Mateo County is seeking a Third-Party Administrator (TPA) to manage its self-insured Workers’ Compensation Program. - Government Buyer: - County of San Mateo, Human Resources Department - Products/Services Requested: - Comprehensive Workers’ Compensation Claims Management Services - Administration of all new and existing claims (approx. 694 open claims) - Includes indemnity, medical, and first aid/info only cases - Claims administration, legal coordination, settlement management, subrogation, reporting, and compliance - Managed Care Cost Containment Services - Bill review, utilization review, nurse case management, and investigation - County approval required for all third-party vendors used for these services - Data Integration and Security - Integration with Origami Risk Management Information System - Data security and confidentiality required - Staffing Requirements: - Dedicated team including Claims Supervisors, Senior Claims Examiners, Future Medical Claims Examiners, and Assistant Claims Examiners - Flexibility for proposers to suggest alternative staffing structures - Unique/Notable Requirements: - Compliance with California Workers’ Compensation laws - County reserves right to approve all third-party vendors for managed care services - Support for data integration with Origami Risk - No specific OEMs or vendors named; open to all qualified TPAs - Contract Term: - Three years, with an option to extend for two additional years

Description

The County of San Mateo is seeking proposals from qualified Third-Party Administrators to provide Workers’ Compensation Claims Management and Managed-Care Cost Containment Services for its self-insured Workers' Compensation Program. The services will cover all new and existing claims, with approximately 694 open claims currently. The scope includes administrative services, claims administration, staffing qualifications, data security, and contract terms for a three-year period with an option to extend. Proposals must be submitted electronically by July 11, 2026, and will be evaluated based on approach, qualifications, fee proposal, and compliance.

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