Workers’ compensation third party administration and managed care cost containment services RFP

The County of San Mateo is requesting proposals for Workers' Compensation Third Party Administration and Managed Care Cost Containment Services under RFP 2026-RFP-00430, with proposals due July 10, 2026, and an anticipated contract award date of August 7, 2026.

The scope encompasses claims management and cost containment services for the County's self-insured workers' compensation program covering approximately 694 total open claims (643 indemnity, 36 medical, and 15 first aid/info-only) across 7,250 employees in 29 departments. The County requests a staffing structure of 2 fully dedicated Claims Supervisors, 4 fully dedicated Senior Claims Examiners, 1 fully dedicated Future Medical Claims Examiner, and 2 fully dedicated Assistant Claims Examiners, though proposers have flexibility to propose alternatives. The County reserves the option to adjust staffing needs after the first six months and annually thereafter.

Minimum qualifications require five years of workers' compensation third-party administration experience within the last seven years and current service to at least three public entities with a minimum of 7,250 employees, including at least one in California. Claims supervisors and examiners must hold California claims examiner designations and California Self-Insurance Plans certifications, with supervisors and senior claims examiners requiring a minimum of five years' examiner-level experience.

The County uses the Origami Risk Management Information System and requires the TPA's workers' compensation information system to integrate with it. The County also contracts through the TPA for bill review, utilization review, nurse case management, and investigation services. The County maintains zero settlement authority with the selected TPA and requires approval for all medical treatments outside an approved provider network, all utilization review requests, all nurse case management referrals, and all settlement requests.

The contract term is three years with one optional two-year renewal period at the County's sole discretion. The RFP uses best-value evaluation methodology scoring project approach (25 points), firm qualifications (22 points), team qualifications (22 points), and fee proposal (27 points), with 5–10 percent preferential points available for local businesses or non-profits. Proposers must submit annual flat fees covering all standard services with itemized lists of additional services and costs. Questions were due June 12, 2026. Tentative interviews are scheduled for July 24, 2026. The incumbent is Athens Insurance Service, Inc. dba Athens Administrators, under a contract extended through June 30, 2027.