HPCC Claims Review PWS - v.1.1.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 compensation to the Claims Office to ensure the expeditious resolution of claims through a process that is administered with sensitivity to the burdens placed upon claimants impacted by the Hermit’s Peak/Calf Canyon Fire and resulting losses as further defined by Congress.

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 victims affected by the Hermit’s Peak/Calf Canyon Fire. Since Injured Persons can submit multiple claims, at this time FEMA estimates a total of 28,000 claims that will be submitted before the anticipated deadline, November 14, 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. Preliminary projections suggest an estimated total of 28,000 claims, with multiple claims submitted by each claimant. From November 14, 2022 until March 2024, FEMA has received more than 7,000 Notices of Loss, with approximately 50% submitted by 3rd party representatives. FEMA anticipates an additional 5,000 Notices of Loss submitted under the

Period of Performance of this contract, which are all anticipated to be submitted by the

November 2024 regulatory deadline.

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 and improving an accurate claimant-focused process that emphasizes speed, excellent customer experience, reduction of complexity, and processing transparency in accordance with established program guidance.

Objective 2: Assist the Government with executing and improving a time-efficient, accurate, and cost-effective claims intake process and best in class customer service support. The Contractor shall assist the Government in providing expeditious claim development, review, and submit recommendations for determination amounts.

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 to expeditiously collect adequate supporting documentation, submit proofs of loss, review qualified amounts, duplication of benefits, and submit a recommendation for compensation determination amounts. The Contractor must perform those services in accordance with the terms of 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 and continually increases efficiency and effectiveness. 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 12: 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)

• Draft Interim Final Regulations (https://www.regulations.gov/document/FEMA-2022-

0037-0001); subject to change.

• Hermit’s Peak/Calf Canyon Fire Assistance Act Final Rule

(https://www.federalregister.gov/documents/2023/08/29/2023-18457/hermits-peakcalf-canyon-fire-assistance)

• 44 CFR Part 296 (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 12: Tasks.

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.regulations.gov/document/FEMA-2022-0037-0001 https://www.regulations.gov/document/FEMA-2022-0037-0001 https://www.federalregister.gov/documents/2023/08/29/2023-18457/hermits-peakcalf-canyon-fire-assistance https://www.federalregister.gov/documents/2023/08/29/2023-18457/hermits-peakcalf-canyon-fire-assistance 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

Projections: FEMA projects an estimated total of 5,000 additional Notices of Loss, with multiple claims submitted by each claimant. 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 hours must be requested and approved by the

Contracting Officer Representative (COR) or Technical Monitor (TM) in advance of overtime hours being worked.

Spanish-language Proficiency: up to 10% of specialists should be proficient in Spanish;

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

The COR, 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.

Use of Local Firms and/or Employees: The Contractor shall, to the maximum extent possible, create opportunities for the utilization of local employees, firms, and small businesses, including the utilizing of businesses from underserved communities. Local is defined as within or adjacent to the affected counties in New Mexico: San Miguel, Mora, Santa Fe, Taos, Colfax, and surrounding counties.

The Contractor shall also, to the maximum extent possible, develop a plan to utilize local firms and/or hire local residents. The Contractor will prepare a tracker that shows the labor mix on the task order level. It will illustrate, at a minimum, the labor category, number of personnel, monetary value, and local versus non-local firms and any other labor and/or staffing related trend as identified by the Contracting Officer (CO). In addition, upon request, the Contractor will provide an addendum to their personnel report that shows how it intends to maximize, to the highest extent practicable, the use of local firms and residents to supplement its labor pool in support of this contract. The Contractor will be required to meet goals as set by the CO regarding local versus non-local firms.

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 specialists.

8. PLACE OF PERFORMANCE: Any positions requiring on-site support should anticipate travel/deployment to 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. Additionally, on-site support may be requested at FEMA Headquarters in Washington, DC and FEMA Region

6 Offices in Denton, TX. 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 the work tasks the personnel are performing necessitating onsite or remote support.

FEMA has established a primary office in Santa Fe, New Mexico, which may accommodate up to

150 Contractor staff personnel. FEMA has established secondary field offices in San Miguel

County and Mora County, and may establish filed offices in Sandoval County and Rio Arriba

County, New Mexico, which may accommodate up to 25 Contractor personnel at each location.

9. CONTRACT TYPE: The Government anticipates the need for a hybrid Time-and-Materials and Firm Fixed Price (FFP) contract. Claims processing, from receipt of Proof of Loss to submission of Letter of Recommendation for Payment to the Authorizing Official, shall be billed as a Fixed Unit Price per submitted and accepted Letter of Recommendation. Designated contractor claims reviewers shall not bill any additional charges under T&M.

All other ancillary services, including Claims Intake and other services outlined in the this PWS and Table 2 – Performance Requirements Summary, shall be billed under the T&M CLIN. The

Estimated Level of Effort for non-Claims Processing services is estimated to be 75,000 hours in

Base Year, and 50,000 hours for all subsequent Option Periods.

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

11. DEPLOYMENT 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. 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. If specialists are deployed to Temporary Duty Station (TDY), the

Contractor shall demobilize within 48 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 specialists’

Residence of Record (ROR) will be determined at the Kick Off Meeting. The FEMA TM must approve travel prior to a specialist being deployed.

12. TRAVEL AND STAFFING:

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

• Additionally, if the proposed specialist(s) 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 Technical Monitor at least fourteen (14) days prior to departure.

• Emergencies aside, the Contractors may take rotations at ninety (90) day intervals beginning 90 consecutive calendar days after arrival on site following travel.

• Rotations shall be for a maximum of seven (7) 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 seven (7) days. Travel time shall be not be billed as labor hours. No accrual of days shall be permitted.

• A Schedule Coordination Notification Form, Travel Cost Analysis (TCA) and backup documentation (if applicable) must be provided to the TM for all rotations fourteen (14) calendar days in advance of departure date.

• For emergency leave, the Contractors required to notify their 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 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 specialist must work a full eight (8) hours prior and following the weekend he/she is authorized.

13. GOVERNMENT-FURNISHED EQUIPMENT AND INFORMATION: FEMA will supply the specialists with Government laptops. All other equipment, to include cellphone, WIFI capability and phone connectivity when supporting, must be provided and are at the expense of the Contractor. Personal protective equipment (PPE) must be provided by the Contractor.

The Contractor shall furnish all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items as necessary to perform the services as defined in this

PWS. The Contractor shall 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 specialists 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 Technical

Monitor.

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

Technical Monitor – TBD

Program POC – TBD

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

14. TASKS: The contractor shall provide qualified claims processors and claims reviewers who provide scalable and cost-effective Claims Intake, Processing, and Customer Service solutions. Claims review activities listed in the tasks below may change based on final claims review process that is developed.

FEMA anticipates a maximum peak of 500 claims-related submissions (e.g., Notices of Loss, Proofs of

Loss, etc.) per calendar week, with an average of four claims per claimant.

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:

mailto:AmandaLibby%2C(202)-853-6690%2CAmanda.libby@fema.dhs.gov

14.1. Assisting the Government with implementing a scalable, customer-focused 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. Developing strategies and implementing solutions to assist claimant and/or FEMA

Navigator to identify losses eligible for payment and requisite backup documentation requirements.

14.3. Developing and utilizing standardized Claims-related valuation methodologies to provide expedited processing, to include:

14.3.1. Reasonable Cost determinations in the absence of actual cost receipts;

14.3.2. Other calculation methodologies, including establishing pre-determined rates, to expedite claims review process.

14.4. Contractor shall apply established procedures for handling all claims-related correspondence, including registrations by mail and upload, and provide mail operations as requested. Contractor shall, when applicable or requested, make recommendations to the Government for improvements to claim-related correspondence and associated procedures.

14.5. Contractor shall provide qualified personnel and claims reviewers to evaluate claims and recommend payment to the Authorized 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:

14.5.1. 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.

14.5.2. If requested by FEMA, contractor shall help claimants formulate strategies for obtaining any necessary documentation or support.

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 designated claimant representative or the

Government’s Navigator and contact the claimant within 24 hours to review Notice of Loss, assist claimant with formulating a strategy for obtaining any necessary supporting documentation to complete the Proof of Loss, and other requirements as specified by the COR.

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 Authorized Official. Claims reviewers shall take all steps including, but not limited to, direct claimant support, independent research (e.g., identifying quotes for loss items), identifying other 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 awarded for injuries or costs that are otherwise eligible for compensation under other applicable programs, including but not limited to Public Assistance Program, Individual Assistance Program, National Flood Insurance Program, and other

Federal programs from agencies such as the Small Business Administration, United States Department of Agriculture, etc.

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

14.9. Claims reviewers shall work with the Government’s designated claimant liaisons, FEMA Navigators and Claimant representatives (e.g., attorneys), to provide assistance to claimants from receipt of Notice of Loss to final payment.

14.9.1. FEMA Navigators will be Government personnel responsible for coordination with claimants throughout the Claimant’s journey including development and submission of Notices of Loss, development of the Proof of Loss, and Claimant acceptance of payment. FEMA Navigators will also serve as liaisons between claims reviewers and Claimants.

14.9.2. Claims Reviewers shall, as requested by the Government (e.g., FEMA

Navigators), communicate directly with Claimants and/or Claimant representatives in the same manner as a FEMA Navigator to facilitate the expeditious processing of claims.

14.9.3. Claims Reviewers shall evaluate claims to identify any suspected or potential fraud. Any claims identified by the contractor as having suspected or potential fraud shall be referred to the Claims Office Appeals, Audits, and Arbitration

Branch for further review and determination.

14.10. Contractor shall ensure 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.

14.11. Contractor shall monitor, at no additional cost to the Government, the compliance and proficiency of contracted staff. Contract shall regularly provide updates to the

Government information related to any quality or training gaps that exist and make recommendations for identified gaps to be resolved.

14.12. Contractor shall provide 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.

14.13. Contractor shall assist the Government to promote the Hermit’s Peak/Calf Canyon

Fire claims program to injured persons.

14.14. 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.

14.15. Provide assistance 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.

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

14.17. 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: Suspected or

Potential Fraud and Financial

Audit Report

The Suspected or Potential Fraud and Financial Audit Report shall identify any claimants and associated claims that require further auditing oversight.

Due to the Government weekly, day and time TBD after Award.

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

Deliverable 2: 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 3:

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 specialists working on task order.

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

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

Deliverable 4: 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 5: Labor Hours

Tracker

Labor Tracker will capture all regular and overtime hours worked for each deployed specialist. 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 will review each product for completeness & accuracy.

Deliverable 6: Bi-Weekly

Overtime Hours Tracker

Overtime Tracker will capture all overtime hours requested for each deployed specialist. The tracker is to be submitted on Thursdays by 12:00 pm EST, requesting overtime hours for the following two weeks.

Due to Government each

Thursday by 12:00 pm

EST of the week before work was performed.

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

Deliverable 7: 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 – 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

25 calendar days FUP 90% 100% inspection – COR will review for completeness and accuracy contractor shall submit letter of recommendation for payment to

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

Claims Reviewer High School Diploma A minimum of five years of experience in claims-related roles, with demonstrated experience evaluating, negotiating, and settling residential and/or commercial claims.

Policy Interpretation: Ability to understand and interpret complex insurance policy language, including exclusions, endorsements, and coverage limits.

Technical Knowledge: Construction-related knowledge and background to accurately assess damage and repair costs.

Damage Assessment: Proficient in assessing property and fire-related damage accurately, which involves understanding the extent of damage, the required repairs, required documentation, and the associated costs.

Clear and Effective Communication: Excellent written and verbal communication skills and knowledge and ability to explain policy and regulations to claimants, FEMA Navigators, and other stakeholders.

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