Workers Compensation Claims Third Party Administrator (TPA)

The State of Nevada, specifically the Department of Business and Industry's Division of Insurance, is seeking a Workers' Compensation Claims Third Party Administrator (TPA) for Insolvency Funds for Self-Insured Employers and Self-Insured Associations. This procurement (Solicitation 74BAI-S3432) is targeting a four-year contract beginning 01/01/2026, subject to Board of Examiners approval. The selected TPA will be responsible for comprehensive claims management of approximately 78 open claims and over 16,000 closed electronic claims, including claim processing, medical bill review, rehabilitation coordination, litigation support, and detailed reporting. The TPA must establish a state bank account for payments, manage electronic and potential paper claim records, and ensure compliance with Nevada statutes and regulations. Evaluation criteria will include demonstrated competence (25%), experience (25%), personnel expertise (20%), and cost (20%), with a potential five percent preference for Nevada-based businesses. Proposals are due by 09/25/2025, with the solicitation originally posted on 08/26/2025.

The procurement does not explicitly specify set-aside designations for disadvantaged enterprises, but does offer a potential five percent preference for Nevada-based businesses. The TPA will be responsible for comprehensive administrative functions including subrogation, excess insurance recovery, and maintaining detailed electronic claim file documentation. The Division of Insurance will fund all claim payments and associated expenses. While no incumbent vendor is specifically identified, the contract requires integration with existing claims management systems and adherence to specific state reporting requirements. Although a precise budget range is not specified, the cost proposal will be a significant component of vendor selection, with vendors required to provide transparent pricing across multiple service categories including annual fees, data conversion, claim opening, hearing and appeal representation, file storage, reporting, medical bill review, and network services. The contract will cover comprehensive claims administration services with potential for ongoing renewal based on performance.