Specifications include, but are not limited to:The Buffalo Public Schools (BPS) is seeking proposals from a qualified third-party administrator (TPA) to provide all services and activities related to claims management in collaboration with Buffalo Public School’s internal process for its Workers Compensation selfinsured program. Proposals must include how the vendor can provide each service outlined below. BPS has over 7,000 employees and 11 different bargaining units. The claims per year for lost time, medical only and record only are estimated to be in the range totaling 400 – 600 per year. Vendor’s dedicated staff to handle this volume should be between 7-8 members, including but not limited to: Claim Adjustors/Claim Representative, Claims Supervisors, Client Services, and Risk Control Specialist . Claims reviews two times per year are required to review cases. a. ACCOUNT MANAGEMENT A claims account manager must be assigned to BPS and be responsible for: • Trouble shooting and providing effective solutions to resolve problems with the service agreement and/or services. • Identify key outcome-based measurements that are tracked and deliver program improvements and cost reduction results. • Monitor claim trends and audit claim handling procedures to ensure a high level of customer service. • Host up to four in person claim reviews per year with participation of the claim adjuster(s) and as needed, defense attorneys and nurse case managers. Status reports are due one week prior to the review. • Coordinate semi-annual management meeting to present service performance metrics, benchmarking, and claim trending/loss analysis reports. • Participate and collaborate in the return-to-work program, safe patient handling program, ergonomics program, and workplace violence prevention program if requested. b. CLAIMS ADMINISTRATION The following must be offered: • TPA must perform all services required to supervise and administer a self-insured workers’ compensation program for BPS. • TPA must provide a toll-free telephone number for BPS and claimants. • TPA will process all claims, including investigation, reserving and payment, filing reports, negotiating, and settling of claims for amount pre-approved by Buffalo Public Schools. • TPA must provide appropriate forms for filing injury reports. Employers Report of Accident (C-2F) can be accessed by BPS. • TPA shall provide all printed Workers’ Compensation forms which Buffalo Public Schools may require, (Report of Injury, authorization forms, benefit letters, delay/denial letters, etc.). • Follows NYS WCB e-filing requirements. • TPA can respond to any questions or inquiries by BPS or claimants within one business day. • Contact with BPS, claimant and medical provider must be made within 24 hours of receipt of all lost time claims. If initial contact is unsuccessful, daily follow-up is required for the next three business days. • TPA will conduct an initial investigation to be completed within 14 days from day of receipt of the claim and, if needed, further investigation completed within 30 days or as soon as all the facts of the case can be gathered reasonably. Please confirm this expectation can be met. • Initial plan of action must be clearly documented in the claim file within 14 days from receipt of the claim and updated every 30-60 days. Supervisory reviews must be documented at a minimum of every 90 days. BPS must have access to documentation. • Initial estimate of reserves established within 14 days of receipt of the claim. Adjusters must document the basis for each reserve calculation. • BPS shall be notified of all reserve increases of $25,000 or more. The rationale for the reserves, the plan of action, mitigation strategy, and status of the claim must be provided.