Workers' Compensation Third-Party Administration Services

The City of Cincinnati is seeking proposals for Workers' Compensation Third-Party Administration (TPA) Services through Request for Proposals (RFP 265X901143) for its self-insured workers' compensation program. The comprehensive services include claims processing and administration, bill review, reserve recommendations, litigation supervision, medical bill pricing review, telephonic nurse case management, and return-to-work program management. Specific requirements include providing data access via secure internet connection, annual SOC1 reporting, and Medicare/Medicaid reporting as a submitting agent, with particular emphasis on expertise in administering self-insured claims for public entities in Ohio and handling firefighter cancer claims. Evaluation criteria will assess vendors across six key areas: experience and expertise (25 points), cost and budget (25 points), local government experience (20 points), innovativeness and creativity (10 points), quality assurance and control (10 points), and economic inclusion (10 points). Written questions must be submitted by January 14, 2026, with all electronic proposals due through the City's Bonfire portal by 12:00 PM ET on January 27, 2026. The contract will commence on January 1, 2027, with an initial three-year term and potential for up to three additional one-year renewal terms, not extending beyond December 31, 2032.

The City has specific requirements for contractor qualifications, including mandatory subcontracting goals for certified Minority/Women Business Enterprises (M/WBEs), with failure to meet participation levels resulting in proposal rejection. Contractors must maintain professional liability insurance of $1,000,000 per occurrence and $3,000,000 aggregate, and general liability insurance of $1,000,000/$2,000,000. Compliance with Cincinnati Municipal Code is required, including adherence to equal employment opportunity standards, living wage provisions (currently $19.27 per hour for full-time employees), and non-discrimination covenants. The City prefers an all-inclusive flat monthly, quarterly, or annual rate structure and will require performance guarantees with fees at risk for accuracy and timeliness in claims processing. While specific budget ranges are not explicitly stated, the 2024 workers' compensation report indicates total benefits paid of $2,528,749.23, with 489 total claims reported and outstanding case reserves of $11,091,967.00, suggesting a significant potential contract value. The City currently operates under Ohio BWC Policy #20005306-0 and serves 6,556 Ohio employees, providing context for the scope and potential complexity of the workers' compensation administration services being sought.