Workers Compensation Claims Third Party Administrator (TPA)

The State of Nevada's Department of Business and Industry, Division of Insurance, is seeking a Workers Compensation Claims Third Party Administrator (TPA) through a competitive Request for Proposal (RFP) process. The solicitation, numbered 74BAI-S3531, is designed to procure comprehensive claims administration services for the Insolvency Fund for Self-Insured Employers and the Insolvency Fund for Self-Insured Associations. The selected TPA will manage approximately 78 open claims and over 16,000 closed claims in electronic format, with responsibilities including claim processing, medical bill review, rehabilitation program coordination, litigation support, and comprehensive reporting. Evaluation of proposals will utilize a weighted scoring system, with 25% each allocated to timely requirement fulfillment, service experience, key personnel expertise, and 15% for RFP conformance, with the remaining 10% focused on cost. The RFP was released on 10/16/2025 with a submission deadline of 11/06/2025, and the anticipated contract start date is 01/01/2026, pending Board of Examiners approval. Vendors must be registered on nevadaepro.com, hold a Nevada business license, and maintain an active SAM.gov registration.

The procurement offers a 5% preference to Nevada-based businesses and requires vendors to comply with specific data protection standards, including data encryption and onshore data maintenance. Potential respondents must meet stringent qualification requirements, including expertise in workers' compensation claims administration and ability to handle complex claims management. While no specific set-aside designations are explicitly mentioned, the state emphasizes compliance with federal and state regulations regarding civil rights, environmental standards, and anti-discrimination statutes. The contract is structured for a four-year term, with the state funding all claim payments and associated expenses. The current claims portfolio reflects a substantial historical claims management burden, with approximately $59.5 million in total paid expenses across claims dating from 1985 to 2022. Vendors will be expected to provide comprehensive claims administration services with a focus on efficient processing, medical management, and regulatory compliance. While a specific contract value is not disclosed, the extensive claims history suggests a significant potential contract value and ongoing financial management responsibility.