Third Party Administration Services for Workers Compensation

The City of Waco, Texas is seeking a Third Party Administrator (TPA) for workers' compensation claims administration and risk management services for its self-funded Workers' Compensation Program. The procurement is structured as a Request for Proposal (RFP 2025-008), targeting a comprehensive claims management solution for the city's approximately 1,700 full-time and 100 part-time/seasonal employees. Required services include managing both new and existing workers' compensation claims, processing payments, coordinating with medical providers, handling state filings, and maintaining an online claims management system accessible to at least six city users. The RFP requires proposers to provide dedicated, Texas-licensed claims handling staff, including an indemnity/medical adjuster, supervisor, and support staff. Evaluation criteria will assess Experience and Qualifications (20 points), Claims Administration and Handling Process (25 points), Technology and Reporting Capabilities (15 points), Overall Cost (20 points), Customer Service (10 points), and Transition and Implementation Plan (10 points). Key procurement dates include a non-mandatory pre-submittal Zoom meeting on February 27, 2025, at 10:00 AM CT, with questions due by March 6, 2025, and proposals due by March 20, 2025, at 2:00 PM CT.

The contract will have an initial 12-month term commencing October 1, 2025, with potential renewals for up to four additional one-year terms, subject to City Council funding approval. No specific set-aside designations or restrictions for disadvantaged enterprises were mentioned in the documents. The current TPA is AS&G Claims Administration Inc., and the city currently maintains an excess workers' compensation insurance policy with a Self-Insured Retention of $750,000 for non-civil service and $900,000 for civil service employees. Proposers can submit pricing as either a flat annual fee or a per-claim fee schedule with differentiated rates for indemnity, medical-only, and record-only claims. Historical data indicates the city experiences between 179-327 total claims annually, with total incurred costs ranging from $1.19 million to $2.17 million per year. The selected TPA must establish a loss fund account funded by the city, maintain specific claim load limits (100 indemnity, 250 medical-only, or 350 combined), and provide regular financial and performance reporting.