RFP 27-3001 - Workers Compensation Third Party Administrator
Description: The California Department of Social Services is seeking a qualified contractor to provide statewide workers’ compensation claims administration, managed care, and cost containment services for IHSS, CalWORKs, and CalFresh Employment and Training; the posting is a Sell Event/RFx rather than a grant program. The contractor will administer new and existing claims, transition open and closed claim data from the current third-party administrator, provide managed care and cost containment, comply with applicable regulations, and process payments through the State Controller’s Office. The anticipated agreement is for three years beginning December 1, 2027, or upon Department of General Services approval, with one optional three-year extension; proposers must have at least five years of relevant California public-entity experience, a California Workers’ Compensation Self-Insurance Administrator Certificate, and a California office with dedicated claims staff.
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The City of Philadelphia seeks an auditor experienced in Pennsylvania workers’ compensation claims to review indemnity payments issued by its third-party administrator for compliance with City requirements, Civil Service Regulation 32, the Pennsylvania Workers’ Compensation Act, and the Pennsylvania Heart and Lung Act. The auditor will sample open and closed claim files, assess payment practices and internal controls, and identify overpayments, including their amount and percentage by audited fiscal year. The initial performance period is expected to be no more than one year, with possible additional terms extending up to five years total subject to City Council authorization.
The City of Philadelphia seeks an auditor experienced in Pennsylvania workers’ compensation claims to review indemnity payments issued by its third-party administrator for compliance with City requirements, Civil Service Regulation 32, the Pennsylvania Workers’ Compensation Act, and the Pennsylvania Heart and Lung Act. The auditor will sample open and closed claim files, assess payment practices and internal controls, and identify overpayments, including their amount and percentage by audited fiscal year. The initial performance period is expected to be no more than one year, with possible additional terms extending up to five years total subject to City Council authorization.
The State of Ohio, through the Department of Administrative Services (DAS), seeks one contractor to administer its self-insured Behavioral Health Benefit Plan, which covers approximately 43,800 employees and 104,600 lives. The contractor will provide claims processing, customer service, reporting, data integration, and related administrative services, with the plan scheduled to start July 1, 2027. Offerors must submit technical and cost proposals, and sign a nondisclosure agreement by November 4, 2026, to access Exhibit 8; proposals are due November 13, 2026.
