Claims Management Third-Party Administration
The Parish of Jefferson, authorized by Resolution No. 140141, is hereby soliciting the submittal of a Statement of Qualifications from qualified firms desiring to provide the Parish with Third Party Claims Administration Services for Liability, Worker’s Compensation, SELA/Property, and Other Assigned Claims for Jefferson Parish, Jefferson Parish Hospital Service District 1 and Jefferson Parish Hospital Service District 2. (Parish-Wide)
Deadline for Submission: 3:30 p.m., September 1, 2022
The Parish of Jefferson maintains a self-funded program for the investigation, negotiation and
Payment of General Liability, Professional Liability, Practices Liability, Employment Practices
Liability, Public Officials and Employee’s Liability, Automobile Liability, Workers’ Compensation,
And other claims brought against it.
The Parish of Jefferson is seeking Statement of Qualifications for Qualified firms to provide all
services, on an annual flat fee basis, in connection with Third Party Claims Administration of
its claims. The successful Respondent shall, as an Independent Contractor, provide all
Third Party Claims Administration Services. It is the desire of the Parish of Jefferson that the
Third Party Claims Administrator only provide claims administration. Services such as, but not
limited to, preferred provider (PPO) networks, medical case management, vocational
rehabilitation, re-pricing of medical bills, life care planning, private investigative services, and litigation management shall not be considered part of this contract. The Parish reserves the
right to select any such vendors and to negotiate service terms.
The Parish of Jefferson will designate legal counsel to be used in legal matters related to its
Minimum Requirements for Selection
A. The Parish of Jefferson cordially invites SOQ from firms that have a minimum of ten (10) years’ Experience in the field of adjusting and handling General Liability, Professional Liability, Employment Practices Liability, Public Officials and Employee’s Liability, Automobile Liability, Workers’ Compensation, and other claims.
B. Respondent Firm shall utilize & provide Jefferson Parish access to a comprehensive claims Management system with the ability to run customizable, scheduled and live reporting.
C. Respondent Firm shall staff and maintain an office within the Parish of Jefferson’s Department of Risk Management offices in order to service its claims. Adjusters shall be dedicated to the Jefferson Parish account.
D. Respondents shall include within their SOQ a description of their firm’s qualifications including the current territory(ies) that it services, coverage lines handled, a listing of memberships in local and national professional organizations, and a list of specific personnel who will be responsible for ensuring the efficiency and quality of service to the Parish of Jefferson and its employees. Resumes are required on each of the key personnel, such as office manager, supervisors and adjusters. These resumes should include any professional designations held by the individuals as well as listing of memberships in professional organizations. Direct experience of adjusting staff will be a determining factor in the Parish of Jefferson’s selection process. Respondents must include a job description for each Classification of the service team.
Because of the pivotal positions of the team, the Parish of Jefferson shall retain the right to meet, review and approve of any potential assignee to the team at the inception of the
service and throughout the term of the contract, which results from the SOQ.
E. Respondents shall supply a list describing similar previous work done, arranged by subject area, stating client’s name (governmental agency or private business) and the names of contact persons for each client listed.
F. Respondents shall supply financial statements for the past three (3) years or other
representation of financial solvency.
Scope of Services
The following items should be addressed in each SOQ, in the order they appear below, for the purpose of guiding the Parish of Jefferson in its evaluation process.A Respondent’s failure to do so will result in the lowering of its rating or the disqualification of the Respondent.
Experience and Professional Qualifications:
A general statement about the company, stating the length of time it has been inbusiness as a Claims Administrator and has been adjusting General Liability, Professional Liability, Employment Practices Liability, Public Officials and Employee’s Liability. Automobile Liability, Workers’ Compensation, SELA/Property, and other claims. Please include the location of the company’s principal office.
Experience including any professional designations, membership, in local and national professional organizations held by the individuals, and the number of staff members. The identity of the person assigned as the account executive for the administration of the Parish of Jefferson’s claims, including a complete resume for this individual. The identities of supervisors and adjusters to provide claims administration, a complete resume for each, the resume should include the number of years of experience in each assigned area, and a description of whatever training is provided.
The Parish of Jefferson reserves the right to accept/reject key personnel.
Indicate the location from which the account will be served, including answers to the following:
The Parish of Jefferson will require the service company to staff and maintain an office within the Parish of Jefferson’s Department of Risk Management offices in order toservice its claims.
Is the Respondent, therefore, willing to set up a fully staffed, office within the Parish’s building?
What is the Respondent’s maximum capacity for its present operations and what modifications in equipment and staffing would be necessary if awarded this contract?
Please provide information concerning backup personnel in the absence of the key personnel.
Your administrative philosophy as it relates to:
Payment or nonpayment of claims;
Method of managing the reporting of claims ;
Injured employee’s work status;
Workers’ Compensation Appeals Bond and Rehabilitation Unit appearances;
Notification of payment or nonpayment decisions to claimant and Parish of
Providing loss information;
Approach to subrogation;
Late payment policy;
Assignment, utilization and monitoring of vendors, e.g. surveillance, rehabilitation counselors, case management.
Your claims administrative system procedures:
Promptness of accident investigation including: procedures utilized by your firm to complete accident investigations and turnaround time from receipt of claim to
File review/diary calendar, frequency of the file review; as a general rule, the Parish of Jefferson requires all cases be reviewed at least every thirty (30) days. Can your firm provide this service? What is the frequency and criteria for supervisory or managerial diary review?
Expectation to subcontract any part of the contract with the Parish of Jefferson;Please explain in detail and identify any potential sub-contractor, including address, contact person and telephone number.Are these costs included in your fee or charged separately to the Parish of Jefferson?What is the method for determining when and if these services are warranted, and what is your firm’s procedure for monitoring these services?This does not include allocated cost expense.
It is the expectation of the Parish of Jefferson that the selected TPA make an aggressive effort to comply with the needs of the Parish. Such needs may require the TPA to provide various reports. The development and preparation of these reports should be included in the final cost of service. The Parish of Jefferson will not be responsible for any costs incurred by the selected TPA to have these reports prepared by subcontractoror outside service, including.The Parish of Jefferson will not be responsible for paying any costs or fees associated with any Parish of Jefferson/TPA meetings or mediations during the term of this contract.
Procedures and guidelines for handling claims (standard service).
Record keeping, correspondence.
The period of retention of a file that is closed or resolved; identify what constitutes a closed file.
Number of employees to be assigned to the administration of the claims, including the maximum number of claims assigned to each adjuster. The Parish of Jefferson shall allow each General Liability, Automobile Liability and other claims adjuster to handle not more than 125 claims at any given time. A minimum of two (2) dedicated casualty claim adjusters will be required. TheseAdjusters will be housed on-site at The Parish’s Department of Risk Management.The Parish of Jefferson shall require one (1) dedicated Workers’ Compensation claim adjuster and one (1) person for Medical only and payment processing.
Type of disaster recovery system or plan in case of catastrophe or other
Subrogation and Second Injury Fund procedures; your firm’s experience based upon percentage recovery and dollar amount over the past three (3) years.
Services provided to walk-in claimants.
Any claims adjustment standards that your firm believes are pertinent.
Jefferson Parish requires daily balance access to the Trust Funds and General Ledger. The Trust Fund accounts will be established by the Parish of Jefferson at its designated banking institution. The TPA will be responsible for the accuracy and information contained in this system. Jefferson Parish will require internet read only access as it relates to the Trust Fund and General Ledger.
The TPA will be responsible for the verification of the legitimacy of payments made to service providers and for the disbursal of the benefits through Jefferson Parish’s check issuance process. Jefferson Parish therefore reserves the right for staff of its office or its designee to conduct audits of financial accountability procedures.
The TPA will be responsible for any and all NSF charges incurred for any reason.
The TPA will be responsible for producing and mailing 1099s, in accordance with Internal Revenue Service regulations, for all claims payments made.
The TPA will be responsible for producing any reports required by regulatory bodies, including but not limited to the LDOL 1000, Annual Report of Workers Compensation Costs and the Second Injury Fund Future Liability Worksheets.
Provide a description of your internal quality control program and the procedures utilized by management personnel to ensure the quality of services to be provided to the Parish of Jefferson.
Claims management system (Risk Management Information System); Describe your firm’s claims management system.
Financial StatementThe Claims Administrator shall furnish, on an annual basis, a copy of the most recent financial report, if available, including all statement and footnote disclosures as required by generally accepted accounting principles. The audit report shall contain an unqualified opinion from a Certified Public Accounting firm, which is acceptable to the Parish of Jefferson. If the claims administrator does not have audited financial reports, the claims administrator shall provide a copy of the most recent internal financial report available.
For which major clients (3,000 or more employees) does your firm presently administer claims? Please provide names and telephone numbers of individuals who may be called as references. Please also indicate the types of claims administered.
Have any clients terminated your firm’s services as a Claims Administrator within the past three (3) years? If so, please identify the client, a contact person and provide a brief description of any reason or background for the termination.
In a brief statement, please describe the principle reason or reasons your organization should be selected as the Claims Administrator for the Parish of Jefferson.
Will your representatives attend meetings concerning claims administration whenever requested to do so by the Parish of Jefferson?
Does your firm agree that all books, claims, files, records, including all electronic data, lists of names, journals and ledgers, tapes, cards and drawings always remain the property of the Parish of Jefferson and your firm uses such exclusively for the Parish of Jefferson, and at the direction of the Parish of Jefferson?
Does your firm agree to cooperate fully with an outside audit of its claims administration processes and procedures?
Does your firm agree to adhere to generally accepted Workers’ Compensation, Automobile and Liability claims administration processes and industry standard practices?
Does your firm agree to provide security and safe keeping of the Parish of Jefferson’s records and to return such records to the Parish of Jefferson if a new administrator is hired in the event your firm’s contract is terminated?
The Claims Administrator must carry insurance coverage that meets or exceeds the minimum insurance coverage requirements outlined in Attachment A.
The following criteria shall be used to evaluate each firm submitting a Statement of Qualifications:
Specific experience- similar or larger scope of services currently being provided (Maximum points awarded shall be 20).
Personnel- Size of firm considering the number of professional and support personnel, experience of management staff, experience in similar projects, etc.(Maximum points shall be 20).
Scope of services- Methodology and resources applied to fulfill the scope of services, staffing and organization, including experience and professional qualifications of key management and claims adjusting personnel who are assigned to the project – (Maximum points shall be 35).
Location of the principal office where work will be performed. Preference shall be given to persons or firms with a principal business office at which the work will be performed as follows: (1) Jefferson Parish, including municipalities located within Jefferson Parish (15 points); (2) Neighboring Parishes of the Greater New Orleans Metropolitan Region, which includes Orleans, Plaquemines, St. Bernard, St. Charles, St. Tammany (12 Points); (3) Parishes other than the foregoing (10 Points); (4) Outside the State of Louisiana (6 Points) (Maximum points awarded shall be 15).
Adversarial legal proceedings between the Parish and the person or firm performing professional services, in which the Parish prevailed or any ongoing adversarial legal proceedings between the Parish and the person of firm performing professional services, excluding those instances or cases where the person or firm was added as an indispensable party, or where the person or firm participated in or assisted the public entity in prosecution of its claim. In the event that the person or firm fails to provide accurate and detailed information regarding legal proceedings with the Parish, including the absence of legal proceedings, the person or firm shall be deemed unresponsive with regard to this category, and zero (0) points shall be awarded (Maximum points awarded shall be 10 for the lack of any such adversarial proceedings as defined).
The person or firm submitting a Statement of Qualification (General Professional Services Questionnaire) must identify all subcontractors who will assist in providing professional services for the project, in the professional services questionnaire. Each subcontractor shall be required to submit a General Professional Services Questionnaire and all documents and information included in the questionnaire. (Refer to Jefferson Parish Code Ordinance, Section 2-928)
The most current General Professional Services Questionnaire must be submitted. A copy of the questionnaire may be obtained by calling the Jefferson Parish Purchasing Department at (504) 364-2678 or (504) 364-2682, or via the Jefferson Parish website at www.jeffparish.net by clicking on “Business & Development”, and then clicking on “Professional Services Questionnaire”. The submitting individuals or firms must identify all subcontractors who would assist in providing professional services for the project. Each subcontractor shall submit a General Professional Services Questionnaire and all documents and information included in the questionnaire. Interested candidates must submit one (1) submission electronically on the Jefferson Parish eProcurement site, Central Bidding.
Submissions will only be accepted electronically via Jefferson Parish’s e-Procurement site, Central Bidding at www.centralauctionhouse.com or www.jeffparishbids.net. Registration is required and free for Jefferson Parish vendors by accessing the following link: www.centralauctionhouse.com/registration.php.
No SOQ submittals will be accepted after the deadline.
Affidavits are not required to be submitted with the Statement of Qualifications, but shall be submitted prior to contract approval, including any sub-contractors.
Disputes/protests relating to the decisions by the evaluation committee or by the Jefferson Parish Council shall be brought before the 24th Judicial District Court.
ADV: The New Orleans Advocate: August 10, 2022