Draft PWS - Hermits Peak Claim Review Technical Support.pdf

Performance Work Statement

Hermit’s Peak/Calf Canyon Claims Review Technical Support

1. PROJECT TITLE: Technical Assistance for the Hermit’s Peak/Calf Canyon Claims Office.

2. PURPOSE: FEMA requires technical assistance in support of the Hermit’s Peak/Calf Canyon

Claims Office (Claims Office). The Claims Office was established in response to the Hermit’s

Peak/Calf Canyon Fire Assistance Act (“The Act”), Division G of Public Law 117-180, 136 Stat.

2114, 2168, which requires FEMA to establish a claims office to receive, evaluate, process, and pay actual compensatory damages for injuries from the Hermit’s Peak/Calf Canyon Fire.

The overarching objective of this contract is to provide support to the Claims Office to ensure expeditious and accurate processing of claims.

3. BACKGROUND: The United States Congress introduced H.R. 7721, Hermit’s Peak Fire

Assistance Act, to compensate impacted entities of the prescribed burn that resulted in the merged

Hermit’s Peak and Calf Canyon Fires in New Mexico for injuries resulting from the fire and to provide for the expeditious consideration and settlement of claims for those injuries. The Act also establishes the Hermit’s Peak/Calf Canyon Fire Claims Office within the Federal Emergency

Management Agency. The Claims Office will receive, process, and pay claims to claimants affected by the Hermit’s Peak/Calf Canyon Fire and subsequent floods. Since Injured Persons can submit multiple claims, at this time FEMA estimates a total of 28,000 claims that will be submitted before the current deadline, December 20, 2024 or as otherwise specified by

Congressional legislation.

The Hermit’s Peak/Calf Canyon fires resulted in 325,340 acres burned and 900 homes/structures destroyed. From November 14, 2022 until October 2024, FEMA has received over 20,000 Proofs of Loss, with approximately 14% submitted by 3rd party representatives. FEMA anticipates an additional 5,000 Proofs of Loss may be developed under the Period of Performance of this contract.

The Contractor shall assist the Government with meeting the following objectives, in conformance with applicable documents and regulations:

Objective 1: Assist the Government with executing a time-efficient, cost-effective, compliant, and accurate claimant-centric process that emphasizes quality customer service, reduction of rework, quality control support, and providing commensurate compensation recommendations in accordance with established program guidance.

Objective 2: Assist the Government with task-specific support in the following areas:

Administrative, Subject Matter Expertise, Site inspections, Appeals and other staff as mission needs dictate in accordance with established program guidance.

4. SCOPE: The Contractor shall be required to provide professional and technical services supporting the Hermit’s Peak/Calf Canyon Claims Office. The Contractor shall provide support in operational areas to include, but not limited to claimant intake, query and collection of requisite supporting documentation, development and submissions of comprehensive proofs of loss, claimant inquiries, review requested amounts, establish qualified amounts, assess duplication of benefits and provide comprehensive recommendations for maximum compensation determinations. The Contractor must perform those services in accordance with the terms of Hermit’s Peak/Calf Canyon Fire Assistance Act (Division G of Pub.L. 117-180), Regulation 44 CFR Part 296, and the contract between the Contractor and FEMA.

The Contractor shall work with the Government to execute a claimant-centric process that puts customer service first, continually increases efficiency and effectiveness, and compiles with respective policy and guidance. FEMA’s overall objective is to provide full compensation available under the law as expeditiously as possible with the smallest burden placed on the claimants. Consequently, a key goal of the program is to support the claimant at every step of the process and to issue Letters of Determination within 90 days after acknowledging a Notice of

Loss, but no later than 180 days from such acknowledgment. Contractor shall deliver operations in a cost-effective, accurate, and timely manner, and maximize use of local firms and personnel in support of the program’s objectives.

The specific tasks are listed in Section 14: Tasks of this Performance Work Statement.

The support requested, POCs, and Periods of Performance (POP) are identified below.

5. APPLICABLE DOCUMENTS AND REGULATIONS:

• Hermit's Peak/Calf Canyon Fire Assistance Act (Act), Division G of Public Law 117-

180, 136 Stat. 2114, 2168 (https://www.govinfo.gov/content/pkg/PLAW-

117publ180/pdf/PLAW-117publ180.pdf)

• Final Regulations (eCFR :: 44 CFR Part 296 -- Hermit's Peak/Calf Canyon Fire

Assistance).

• FEMA Hermit’s Peak Website (https://www.fema.gov/disaster/current/hermits-peak)

• Hermit’s Peak/Calf Canyon Claims Program and Policy Guide

(https://www.fema.gov/sites/default/files/documents/fema_hpcc-hermits-peak-calf-canyon_program-and-policy-guide.pdf)

6. STAFFING REQUEST: The Contractor must provide a technical response that includes a mix of Labor Categories that will demonstrate the ability to complete all required tasks as outlined in this PWS Section 14: Tasks.

Projections: FEMA projects an estimated total of 5,000 additional Proofs of Loss. For every ten

(10) claims reviewers, the contractor shall designate one (1) supervisor who will monitor performance, provide direction, and review work for compliance with Government standards. For bidding purposes, assume that all staff charging under the T&M CLIN will work an average of twenty (20) hours of overtime per week for the Base Period and all Option Periods. All overtime https://www.govinfo.gov/content/pkg/PLAW-117publ180/pdf/PLAW-117publ180.pdf https://www.govinfo.gov/content/pkg/PLAW-117publ180/pdf/PLAW-117publ180.pdf https://www.ecfr.gov/current/title-44/chapter-I/subchapter-E/part-296 https://www.ecfr.gov/current/title-44/chapter-I/subchapter-E/part-296 https://www.fema.gov/disaster/current/hermits-peak https://www.fema.gov/sites/default/files/documents/fema_hpcc-hermits-peak-calf-canyon_program-and-policy-guide.pdf https://www.fema.gov/sites/default/files/documents/fema_hpcc-hermits-peak-calf-canyon_program-and-policy-guide.pdf hours must be requested and approved by the Contracting Officer Representative (COR) or

Technical Monitor (TM) in advance of overtime hours being worked.

The Government will communicate regularly with the Contractor to ensure appropriate staff mix.

The COR/TM, in coordination with Claims Office leadership may review Contractor staffing levels on a weekly basis and will communicate regularly with the Contractor to right-size staffing levels. If the Government deems the staffing mix shall be revised, the Contractor is required to mobilize and arrive at the location specified by the Government within 72 hours of notification from COR/TM.

Conflict of Interest: The Contractor shall ensure all personnel do not review, influence, or submit recommendations for payment on any claims where a conflict of interest may arise (e.g., personal property, family members, etc.).

7. PERIOD OF PERFORMANCE: The period of performance for the base period of the task order is one (1) year from date of award. This requirement is for a one (1) year base period and four (4) one-(1)-year option periods. The Government may extend the terms of the contract, in accordance with FAR 52.217- 8 if required. This will be accomplished by written notice from the

Government to the Contractor of its intent to extend.

Core working hours for all personnel will be determined at the Task Order Kickoff Meeting in accordance with the requesting office and working location of staff.

8. PLACE OF PERFORMANCE: Any positions requiring on-site support should anticipate travel/deployment to government authorized locations within the following counties in New

Mexico: San Miguel County, Mora County, Santa Fe County, Taos County, Sandoval County, Rio Arriba County, and/or Colfax County, and all other surrounding counties affected by the

Hermit’s Peak/Calf Canyon Fire. Contractors may also work from their Residence of Record or other location as directed by the COR. Actual work locations will be determined based on tasks being performed.

FEMA has established a Joint Recovery Office in Santa Fe, New Mexico, which may accommodate up to 300 contractor staff personnel. FEMA has established secondary field offices in San Miguel County and Mora County and may establish field offices in other locations as needed within New Mexico. These additional locations are anticipated to accommodate up to 30 contractor personnel at each location.

9. CONTRACT TYPE: The Government anticipates the need for a hybrid Time-and-Materials

(T&M) and Cost Reimbursement (CR).

All technical services, including ancillary services, shall be billed under the T&M CLIN. Travel, other direct costs, and miscellaneous costs, shall be billed under the CR CLIN.

10. STAFFING QUALIFICATIONS: Staff are not required to hold an insurance adjuster license; however, they must fulfill the minimum qualifications as outlined in Table 3 –

Qualifications.

11. DEPLOYMENT AND DEMOBILIZATION PLAN: All travel requires Government preapproval/preauthorization and notification to the COR/TM. The Contractor shall mobilize all staff to arrive on site within 72 hours of notification or as otherwise directed by the COR/TM. If supporting remotely, the Contractor shall ensure that staff commence work no later than 48 hours following receipt of notification. The Contractor shall demobilize staff at the request of the

COR/TM. If staff are deployed to Temporary Duty Station (TDY), the Contractor shall demobilize within 24 hours of notice or as directed by the COR/TM. Contractor staff supporting remotely shall cease work on the contract within 24 hours of receipt of notification.

Contractor staff will be scheduled to deploy to pick up equipment once usernames/emails accounts are created/confirmed. Equipment pick up location(s) or shipping to staffs’ Residence of

Record (ROR) will be determined at the Kick Off Meeting. The FEMA COR/TM must approve travel prior to staff being deployed.

Contractors are authorized up to eight (8) hours of travel time for mobilization and eight (8) hours of travel time for demobilization. Any travel hours incurred must be included in the total hours authorized for a work week; additional hours will not be authorized to account for travel.

Upon demobilization notification of staff, Contractor shall reassign all work within 48 hours of staff’s exit.

12. TRAVEL AND STAFFING:

• Staff are expected to be committed for the duration of the assignment. This includes the base and option periods. If staff cannot commit for the entire duration, this information should be disclosed in the technical proposal and should include how long the staff is committed.

• Additionally, if the proposed staff are no longer available to support the task order by the time the award is made, it must be brought to the attention of the Contracting Officer, Contracting Officer Representative and Technical Monitor.

• Costs for transportation, lodging, meals and incidental expenses incurred by Contractor personnel on official company business, in support of this contract, are allowable subject to FAR 31.205-46, Travel Costs.

• Rotational travel schedules must be coordinated with the TM/COR at least fourteen (14) days prior to departure and work shall be re-assigned during the duration of the rotation to avoid unnecessary delays in claim processing.

• Emergencies aside, the Contractors may take rotations at ninety (90) day intervals beginning 90 consecutive calendar days after arrival on site following travel. Contractor shall review and approve rotation requests to ensure they align with FEMA Travel Policy and the terms of this contract. Contractor shall ensure that note more than 50% of staff are on rotation at any one time. If staff are structured into teams, then Contractor shall ensure not more than 50% of staff per team are on rotation at any one time.

• Rotations shall be for a minimum of seven (7) days and a maximum of fourteen (14) calendar days (including travel days) as long it is operationally permissible and does not adversely impact the mission. No accrual of days shall be permitted. For bidding purposes assume fourteen (14) days. Travel time shall be not be billed as labor hours. No accrual of days shall be permitted. Extension of rotation beyond the allowable

• A Schedule Coordination Notification Form, Travel Cost Analysis (TCA) and backup documentation (if applicable) must be provided to the TM/COR for all rotations fourteen

(14) calendar days in advance of departure date.

• For emergency leave, the Contractors required to notify their TM/COR of their departure and anticipated return date as soon as practicable. Emergency leave travel costs are not reimbursable by the government.

• Cost effective weekends (CEW) are not authorized unless there is an operational period of at least two (2) consecutive non-working days. No more than one (1) CEW will be authorized each month. The request must be made at least fourteen (14) days in advance of the proposed departure date. Cost analysis documentation must be included with the request. Additionally, the staff must work a full eight (8) hour day prior and following the weekend he/she is authorized.

13. GOVERNMENT-FURNISHED EQUIPMENT AND INFORMATION: FEMA will supply the staff with Government laptops, cell phone, and monitor, and other peripherals as mission needs dictate. All work-related communication and work must be performed utilizing government-furnished equipment. Personal protective equipment (PPE) must be provided by the

Contractor.

The Contractor shall provide staff with the following material: equipment, supplies, tools, and other items as necessary to perform the services as defined in this PWS. The Contractor shall provide reservations for means of transportation, on-site management and supervision, and other services required to perform to the standards in this contract.

In accordance with the Rehabilitation Act of 1973, as amended Section 504 (Programs, Services and Activities) and Section 508 (Electronic and Information Technology), FEMA will provide applicable accessible information technology systems to staff covered under the Rehabilitation

Act of 1973. Based on the Contractor specific need, FEMA will provide accessibility related software or peripheral devices to use systems that comply with Section 508.

The Contractor/Provider shall comply fully with Section 504 of the Rehabilitation Act of 1973, as amended, and incorporate this language in any sub-contracts related to the provision of FEMA public-facing program or activity.

Security: All candidates must be badged (possess a unique identifier) or currently eligible to receive a physical badge (must have an Approved Entry on Duty (EOD) Artifact from FEMA

Security) by the time of proposal. If a candidate is badged, the Contractor must note the applicant’s name as it appears on the DHS Form 11000.25 – Contractor Fitness/Security

Screening Request, the unique identifier (from the badge) and the personal handle number in the “Qualifications of Proposed Personnel” section of their proposal. If the candidate does not have a physical badge, the Contractor must denote the applicant’s name as it appears the DHS

Form 11000.25 – Contractor Fitness/Security Screening Request, the EOD notification date from the EOD Artifact and the person handle number. Proposed candidates cannot be current FEMA employees. If the candidate is a former FEMA employee, their separation must be processed before they are proposed. Upon submission of the proposal, the Contractor must provide the names of all Contractor staff so that FEMA may verify their security status and for FEMA IT system access (if applicable). The Contractor Security Liaison must ensure that security artifacts for all Contractors are up to date prior to deployment. All Contractor staff must be vetted to work on this contract. Contractors are not to deploy until they receive approval from the COR/TM.

Upon task order award and verification of the Contractor personnel security status, the personnel must report to the COR and POC addressed below:

Contracting Officer Representative – Jennifer Cutrona

Program POC – Jennifer Carbajal

Please see Security & Privacy Clauses’ attachment for detailed information regarding relevant clauses.

14. TASKS: The contractor shall furnish staff who provide comprehensive support for both claims review functions and ancillary tasks as required. Contractor shall provide staff support which is scalable and cost-effective to include: Administrative functions, Subject Matter Experts (SMEs) specialists, Site

Inspectors, Appeals Analysts, Claims Reviewers, Quality Control, and other staff as mission needs require within the scope of the PWS. Activities listed in the tasks below may change based on program and policy revisions.

Contractor shall provide program support services for the execution of the life cycle of the claims review process of the Hermit’s Peak/Calf Canyon Claims Office, which may include:

14.1. Assisting the Government with executing a scalable, customer-centric claims review process that provides full compensation available under the law as expeditiously as possible with the smallest burden placed on the claimants.

14.2. Assisting claimant and/or FEMA Navigator to identify losses eligible for payment and obtaining requisite backup documentation requirements.

14.3. Utilizing valuation methodologies to conduct claims processing, including standard rate calculation methodologies to expedite claims review process.

14.4. Apply established procedures for handling all claims-related correspondence, including registrations by mail and upload, and provide mail operations as requested.

14.5. Contractor shall provide qualified personnel and claims reviewers to process claims and recommend payment to the Authorizing Official within the timelines specified in the Table 2 – Performance Requirements Summary. Claims reviewers shall provide other services as identified in the Final Regulations and associated policies, guidance, and procedures, to include but not limited to using guidance provided by the

Government, identify when a Site Inspection or SME Report may be required and refer request to the designated Site Inspection and SME teams.

14.6. Upon receipt and review of a completed and properly signed Notice of Loss the

Contractor shall be responsible to assign a designated claims reviewer for each claim.

14.7. Claims Reviewers shall work with the claimant, designated claimant representative or the Navigator to assist claimant with formulating a strategy for obtaining any necessary supporting documentation to complete a Proof of Loss, and other requirements as specified by the COR/TM.

14.7.1. Claims Reviewers shall follow established guidance, policies, and procedures to provide objective evaluation of claims and provide a detailed report of recommendations to an Authorizing Official. Claims reviewers shall take all steps including, but not limited to, providing claimant support, identifying all potential losses for compensation, and making full use of standard rate calculators to maximize compensation to claimants within the extent of the law.

14.7.2. Claims Reviewers shall evaluate claims to ensure compensation is not duplicated with benefits provided by other applicable programs, including but not limited to

Public Assistance Program, Individual Assistance Program, and other programs.

14.8. The contractor shall provide Quality Control staff to review submissions of comprehensive proofs of loss, claimant inquiries, review requested amounts, establish qualified amounts, assess duplication of benefits and provide comprehensive recommendations for maximum compensation determinations.

14.8.1. Quality Control staff shall notify the Claims Reviewer of any items in the claim that require rework, additional documentation, or updated compensation determination.

14.8.2. Quality Control staff shall complete their reviews in accordance with regulations, policy, and established program guidance.

14.9. Coordinate with subject matter experts and site inspectors, including other government contractors for the purpose of receiving reports or analysis for the processing and validation of claims.

14.10. Contractor shall provide site inspection support as required. If physical site inspections are required, the Contractor shall provide qualified site inspectors personnel to conduct physical site inspections of damaged properties in the affected counties. The site inspection process is as follows:

14.10.1. Contractor shall work with claimant and/or claimant representative to schedule a physical site inspection. If requested to contact claimant directly, Contractor shall make 3 separate attempts to contact the claimant within a 72-hour time period. If contact with the claimant is unsuccessful, the Contractor shall notify the Government within 24 hours.

14.10.2. Completed site inspection packets shall include, at a minimum, a description of the site and any visible damage resulting from the fire, surrounding vegetation, pictures of the site, coordinates, floodplain data, and other information identified by the Claims Reviewer or in the System of Record.

14.10.3. Contractor shall upload completed site inspection package into the System of

Record within 48 hours of site inspection visit.

14.10.4. Maintain a site inspection tracker that includes, at a minimum, claimant name, date of call, date of inspection, completed inspection date, and other pertinent information identified by the COR/TM.

14.11. Contractor shall produce Subject Matter Expert Reports in the areas including, but not limited to: Forensic Accounting, Reforestation, Risk Reduction, Forestry, Fraud, GIS, Xactimate, and Adobe structures. These reports shall be created and added to claims as documentation to determine allowable payable costs claimed based on the legislation, regulations, and policies of the Claims Office.

14.11.1. Contractor shall provide SME support to evaluate compensation for applicable risk reduction/mitigation activities (e.g., fire, flood, watersheds, floodplains, forested areas, etc.). Responsibilities include:

14.11.2. Evaluate whether requested compensation does not exceed thresholds established in the Final Regulations and/or program policy.

14.11.3. Verify and validate whether risk reduction projects were completed.

Verification and validation activities may take place during the claims process or after claims payments are made.

14.12. Contractor shall provide coaching support for Claims review and QC teams.

Coaching support includes, but is not limited to: claims review, system of record, and

Claims Office regulations and policy.

14.13. Contractor shall coordinate with subject matter experts, including other government contractors for the purpose of processing and validation of claims, to include receiving reports or analysis.

14.14. Evaluating claims to identify and flag any suspected or potential fraud. Any claims identified by the contractor as having suspected or potential fraud shall be referred to the Government.

14.15. Review claims through an established quality control process. Any claims that have deficiencies, inconsistencies, or errors are returned to the claims review process.

14.16. Ensuring all claims reviewers complete and maintain proficiency in Government-provided initial, refresher, and ongoing training. Unless explicitly directed, in writing, by the Government, Contractor is expressly prohibited from developing and delivering trainings which deviate from official program guidance.

14.17. Monitoring the compliance and proficiency of contracted staff. Contractor shall address any quality or training gaps that exist.

14.18. Providing exceptional customer service to each claimant and positively and professionally represent FEMA to the public throughout all aspects of services provided on FEMA’s behalf.

14.19. Contractor may be required to travel to claimant’s residence or locations designated by FEMA to assist with the claim process. The Contractor may be tasked with contacting claimant, scheduling date and time of visit, assist with obtaining documentation, completing necessary forms, and collecting and uploading copies of supporting documentation.

14.20. Assisting in document retrieval, as requested, to support the Appeals, Audits, and

Arbitration of the Claims Office, and other backup documentation requests, at the direction of the Government.

14.21. Submit all Reports as requested in Table 1 – Reports. Perform all work to the timelines and standards listed in Table 2 – Performance Requirements Summary.

14.22. If Government awards a follow-on contract, assist with any program handoff and transition services as requested.

15. DELIVERABLES AND DELIVERY SCHEDULE:

The deliverables shall be transferred to the Government via Microsoft Word, Access, Excel or any other media as determined acceptable by the Government. The program will develop and/or amend procedures, guidelines, workflows, and other framework documents to further clarify work. For the purposes of the proposal, any discrepancy between the PWS and guidelines, the

PWS will take precedence, unless specifically excepted by the Government.

Table 1 - REPORTS

Deliverable Requirement

Deliverable 1: Kick Off

Meeting & Report

The Contractor will participate in a kick-off meeting with the

Government no later than five (5) business days after task order award. The Contractor must submit notes and applicable action items no later (3) business days after the meeting is conducted.

Due within 5 days of Task

Order Award (Meeting) and

3 days after meeting

(Report)

100% Inspection TM/COR will review each product for completeness & accuracy.

Deliverable 2:

Accountability Tracker

Accountability Tracker is to be completed and submitted each workday prior to 9:30am (Based on Time-Zone of the requesting office). Tracker should account for vacations, rotations, holidays, sick days, demobilizations, and absentees. Tracker should reflect the day, month, and the availability status of all contracted staff working on task order.

Due to the Government daily 9:30am (Time zone of the requesting office).

100% Inspection TM/COR will review each product for completeness & accuracy.

Deliverable 3: Monthly Task

Order Status Report

Report summarizing overall Task Order status, number of personnel, hours expended for the current month, as well as a summary of deliverables submitted, planned activities for the next month and problems and proposed corrective actions.

Due to the Government by the

15th of each Month.

100% Inspection –

TM/COR will review each product for completeness & accuracy.

Deliverable 4: Labor Hours

Tracker

Labor Tracker will capture all regular and overtime hours worked for each deployed staff. The tracker is to be submitted each Monday by 5:00 pm EST, capturing all labor and overtime for the previous work week.

Due to the Government each Monday 5:00 pm EST of the following week work was performed.

100% Inspection – TM/COR will review each product for completeness & accuracy.

Deliverable 5: Quality Control

Plan

The Quality Control Plan (QCP) to the government within 10 days after the kickoff meeting. At a minimum, the QCP must include the task, performance objective, performance standard, primary method of surveillance, the acceptable quality level, and the evaluation method.

Due to the government within

10 days after the Task Order kickoff meeting.

100% Inspection – TM/COR will review each product for completeness.

Deliverable 6: Claims Status

Tracker

The Claims Status Tracker shall track claims movement by staff and claim movement stage. This tracker will include any claims worked by a claims reviewer, QC, and the stage(s) that the claim moved though, to include development. Tracker shall also include Site Inspections requested and completed, and SME Reports requested and completed.

Format of the report shall be developed in coordination with FEMA after Award.

Due to the Government each

Monday 5:00 pm EST of the following week work was performed.

100% Inspection – TM/COR will review each product for completeness.

Table 2 - PERFORMANCE REQUIREMENTS SUMMARY

PRS # Performance Tasks Requirement Contract Requirement CLIN Type Threshold Surveillance Method

1 Claims Intake

Stage

1.1 SOR entry < 150

Weekly

Upon receipt of Notice of Loss (NoL), which may be submitted by mail, email, or in person, enter claimant and NOL information into SOR.

24 hours T&M 95% Random Sampling or 100% inspection - COR, TM, or other

QA designee

1.2 Letter of

Acknowledgement

< 150 Weekly

Upon receipt of NoL which may be submitted by mail, email, or in person, review the submitted documentation for accuracy (e.g., signature) and send Letter of Acknowledgement to claimant, including any additional written or electronic acknowledgement, within 21 business days.

21 business days T&M 95% Random Sampling or 100% inspection - COR, TM, or other

QA designee

1.3 Contact Claimant

< 150 Weekly

Contact primary claimant or applicable third party within 3 calendar days of date listed on Letter of Acknowledgement.

Make a minimum of 3 separate attempts within 72 hours to contact the claimant or applicable third-party representative to initiate the introductory meeting.

3 calendar days T&M 95% Random Sampling or 100% inspection - COR, TM, or other

QA designee

2 NoL Stage

2.1 Site Inspection or

SME Report

Requests < 50

Weekly

If requested, coordinate with the designated site inspection team, claimant and navigator to schedule site inspection or SME report to verify real property or risk reduction activity or other purposes as defined by the Government. Contractor shall contact claimant and navigator within 3 business days of site inspection request.

3 business days T&M 95% Random Sampling or 100% inspection - COR, TM, or other

QA designee

2.2 Third-Party

Assessments

< 30 Weekly

If requested, coordinate with claimant and navigator to schedule third-party valuations or appraisals and submit third-party quote for requested assessment within 3 business days to COR.

3 business days T&M 95% Random Sampling or 100% inspection - COR, TM, or other

QA designee

3 PoL Stage

3.1 Claims Processing

- 1-50 Weekly

POLs

Upon receipt of a fully documented and completed PoL, claims reviewers shall review, investigate, and objectively evaluate POL to assess eligibility and valuation of losses. The contractor shall submit letter of recommendation for payment to Authorized

Official within 10 calendar days, the Government will have 96 hours to review the recommendation for payment The contractor shall address any errors or omissions identified by the

Government within 1 business day at no additional cost to the

Government.

10 calendar days FUP 95% 100% inspection – COR will review for completeness and accuracy

3.2 Claims Processing

- 51-100 Weekly

POLs

Upon receipt of a fully documented completed PoL, claims reviewers shall review, investigate, and objectively evaluate POL to assess eligibility and valuation of losses. The contractor shall submit letter of recommendation for payment to Authorized

Official within 14 calendar days, the Government will have 96 hours to review the recommendation for payment The contractor shall address any errors or omissions identified by the

Government within 1 business day at no additional cost to the

Government.

14 calendar days FUP 90% 100% inspection – COR will review for completeness and accuracy

3.3 Third Party Claims

Processing - 1-25

Weekly POLs

Upon receipt of a fully documented and completed Third Party

PoL, claims reviewers shall review, investigate, and objectively evaluate POL to assess eligibility and valuation of losses. The contractor shall submit letter of recommendation for payment to

Authorized Official within 21 calendar days, the Government will have 96 hours to review the recommendation for payment

The contractor shall address any errors or omissions identified by the Government within 1 business day at no additional cost to the

Government.

21 calendar days FUP 95% 100% inspection – COR will review for completeness and accuracy

3.4 Third Party Claims

Processing - 26-50

Weekly POLs

Upon receipt of a fully documented and completed Third-Party

PoL, claims reviewers shall review, investigate, and objectively evaluate POL to assess eligibility and valuation of losses. The contractor shall submit letter of recommendation for payment to

25 calendar days FUP 90% 100% inspection – COR will review for completeness and accuracy

Authorized Official within 28 calendar days, the Government will have 96 hours to review the recommendation for payment

The contractor shall address any errors or omissions identified by the Government within 1 business day at no additional cost to the

Government.

3.6 Clock Stop

Request

Submit a clock stop request to COR or other designee within 72 hours of receipt of PoL identifying the reason for the clock stop request (e.g., lack of documentation, etc.).

72 hours N/A 95%

4 LoD Stage

4.1 Letter of

Determination

Upon approval of Letter of Determination in SOR from

Authorized Official, process, download, QC, and mail, email, or otherwise transmit LoD to claimant or third-party representative within 1 business day.

1 business days T&M 95% 100% inspection – COR will review for completeness and accuracy

4.2 Release and

Certification – 90 day deadline

If directed, contact claimant to verify status of R&C at 90 days after LoD date and document status in SoR within 24 hours of contact.

24 hours T&M 95% 100% inspection – COR will review for completeness and accuracy

4.3 Release and

Certification - 120-day deadline

If directed, contact claimant to verify status of R&C at 90 days after LoD date and document status in SoR within 24 hours of contact.

24 hours T&M 95% 100% inspection – COR will review for completeness and accuracy

Table 3 - QUALIFICATIONS

Job Title Education Experience Skills and Knowledge

Administrative Support High School Diploma A minimum of five years of combined experience in administrative roles including customer service, data entry, document development, correspondence, adhering to federal guidance and policy, records management, and evaluating various types of administrative documents.

Policy Interpretation: Ability to understand and interpret complex federal policy language, including relevant statutes, regulations, policies, guidance, and directions.

Administrative Knowledge: Proficiency in administrative activities within an organization including customer service, data management, records management, time management, workload balancing, data reporting and tracking, and other administrative duties.

Clear and Effective Communication: Customer service, excellent written and verbal communication skills and knowledge and ability to explain policy and regulations to claimants, FEMA staff, and other stakeholders.

Use of Technology: Proficiency in using administrative software, claims management software, databases, and other technology tools that facilitate claim processing, documentation, and communication.

Claims Reviewer/Quality

Control/Appeals

High School Diploma A minimum of five years of combined experience in claim/case processing roles including customer service, data entry, reviewing, and evaluating various types of disaster related losses.

Policy Interpretation: Ability to understand and interpret

Technical Knowledge: Disaster-related knowledge and background to accurately assess losses, damages, repairs, and replacement costs.

Use of Technology: Proficiency in using claims management software, databases, and other technology tools that facilitate claim processing, documentation, and communication.

Subject Matter Experts Bachelors Degree in related field A minimum of five years of combined experience in customer service, claim/case processing roles including data entry, reviewing, and evaluating various types of disaster related losses.

Policy Interpretation: Ability to understand and interpret replacement costs in line with subject matter areas of expertise.

SME Reports: Must be proficient and have a high degree of knowledge on how to accurately build SME reports which provide adequate compensation for claimants to rebuild and recover. Must be proficient in assessing property and fire-related and flood-related damage accurately, which involves understanding the extent of damage, the required repairs, required documentation, and associated costs.

Site Inspectors High School Diploma A minimum of five years of combined experience in claim/case processing roles including customer service, data entry, reviewing, and evaluating various types of disaster related losses.

Policy Interpretation: Ability to understand and interpret replacement costs. Must be an expert in using Xactimate software.

Damage Assessments: Must be proficient and have a high degree of knowledge on how to use Xactimate to accurately structure POLs to provide adequate compensation for claimants to rebuild. Must be proficient in assessing property and fire-related and flood-related damage accurately, which involves understanding the extent of damage, the required repairs, required documentation, and associated costs.