Workers' Compensation and General Liability Claim Administration

Summary (Newest Update)

Background The Milwaukee Board of School Directors (MPS) is seeking proposals for claim administrator services related to Workers’ Compensation and General Liability claims. The goal is to engage a qualified contractor to provide comprehensive Third-Party Administration (TPA) services for MPS’s worker’s compensation and general liability programs, ensuring compliance with state laws and effective management of claims. Work Details The contractor will perform the following tasks: 1. Receive, review, and process claims in accordance with MPS rules and Wisconsin state law. 2. Establish and maintain organized claim files available for MPS inspection. 3. Provide effective customer service regarding claim status and benefit determinations. 4. Complete initial investigations within 5 days of claim receipt and further investigations as needed within 10 days. 5. Make compensability determinations within 14 days of file receipt, providing necessary notifications to employees. 6. Maintain detailed adjuster notes on each claim, including exposure comments and closure plans. 7. Provide comprehensive status reports for claims exceeding $50,000. 8. Handle all billing reviews ensuring compliance with fee schedules, identifying duplicate billings, and managing timely payments. 9. Ensure compliance with HIPAA regulations regarding Protected Health Information (PHI). 10. Manage litigation processes in collaboration with the Office of the City Attorney (OCA). 11. Utilize a web-based Risk Management Information System (RMIS) for claims management that meets specific security standards. Period of Performance The contract is anticipated to commence on July 1, 2026, and run through June 30, 2027, with options for four additional one-year extensions based on performance metrics. Place of Performance Services will be performed at locations designated by the Milwaukee Board of School Directors within Milwaukee, Wisconsin. Bidder Requirements Bidders must comply with the Historically Underutilized Business (HUB) participation requirements set at 0% per 12-month term. Additionally, there is a Student Engagement requirement of 100 hours of student employment per term and 10 hours of career education per term. Bidders must also submit required forms including Appendix B - Prime Vendor Information Sheet and either Schedule H1-A or H1-C related to student employment commitments.