2-2022 SI-40.pdf

This is a Scope of Work document for the City of Cincinnati's Workers' Compensation Third-Party Administration Services contract. The City seeks a third-party administrator to manage its self-insured workers' compensation program and provide nurse case management services for the Return to Work Program. The scope encompasses comprehensive claims administration, including receipt and processing of workers' compensation claims, benefit calculations and payment processing, medical management and bill review, return-to-work coordination, and regulatory compliance reporting. The administrator must maintain a local presence or designate a local representative in the Cincinnati area and provide 24/7 claims reporting capabilities. The contract term is for three years with two optional one-year renewal periods. Responses were required by a specified deadline, with award anticipated upon completion of the evaluation process. The successful vendor must demonstrate experience administering workers' compensation programs for public sector employers and possess all necessary licenses and certifications required by Ohio law.

The pricing structure requires the vendor to submit a detailed fee schedule including per-claim processing fees, case management fees, and administrative service charges, with cost proposals evaluated as part of the overall vendor selection criteria. No specific set-asides or reserve requirements are indicated in the scope. The City currently operates a self-insured program and seeks to maintain continuity of services while potentially improving program efficiency and outcomes through professional third-party administration. The vendor must comply with all applicable Ohio workers' compensation laws and regulations, maintain appropriate insurance coverage, and provide detailed performance metrics and quarterly reporting on claims management, return-to-work outcomes, and program costs.