BUILDINGA Better Claims RFP

BUILDING

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Building A Better Claims RFP What We Will Learn

•The Importance of the Request for Proposal (RFP)

• Sampling the Market

•RFP Team Development•RFP Team Development

•Developing Tactical Questions

• Lack of Preparation Consequences

Alternative Service Concepts, L.L.C.

Building A Better Claims RFP RFP Importance

•Price or “Flight”Due DiligenceImmediate Concerns

• Short‐Term Exercise = Long Term ImpactPrepare A ListFormal Presentations

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Building A Better Claims RFP Market Sampling

•Making ChoicesPricingBrokersIndustry PeersCase StudiesReferences

R t f I f ti (RFI)• Request for Information (RFI)High‐Level Data Gathering

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Building A Better Claims RFP Team Development

•Gather the “Thought” ExpertsRisk Professionals & Other Personnel

• Identify CostsNot All TPA’s Are Created Equal

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Building A Better Claims RFP Team Development

• Identify FlexibilityChoice In Subcontractors or Pre‐SelectedStaffing RequirementsRegulatory ComplianceSystem CapabilitiesRehab Program

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Building A Better Claims RFP Tactical Questions

• TPA HistoryGrowthGrowthResearchRetentionOwnership/ManagementOwnership/Management

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Building A Better Claims RFP Tactical Questions

• StaffingAdjuster ExpertiseAdjuster ExpertiseBackup PlansAvailabilityTTurnover

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Building A Better Claims RFP Tactical Questions

• Claim Handling StandardsGuidelinesGuidelines CAT ClaimsRun‐In/Tail ClaimsRecords OwnershipRecords Ownership

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Building A Better Claims RFP Tactical Questions

• Risk Management Information Systems (RMIS)Internal vs LeasedInternal vs. LeasedCapabilities

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Building A Better Claims RFP Tactical Questions

•Migration/ImplementationTimingTimingExpertise

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Building A Better Claims RFP Tactical Questions

• TrainingFor AdjustersFor AdjustersFor Clients

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Building A Better Claims RFP Tactical Questions

• Industry ExpertiseMarketing CollateralMarketing CollateralWord‐of‐MouthCompetitive Analysis

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Building A Better Claims RFP Tactical Questions

• AccountabilityCertificate of InsuranceCertificate of InsuranceTPA Licensure by StatePending LitigationFinancialsFinancials

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Building A Better Claims RFP Tactical Questions

• Quality ControlAuditsAuditsEfficiency ProgramsBackup Plan

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Building A Better Claims RFP Tactical Questions

• Managed CareOwnership or LeasedOwnership or LeasedChoice In PPO NetworksCase Management

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Building A Better Claims RFP Tactical Questions

• Bill ReviewAdjuster InvolvementAdjuster InvolvementProcess

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Building A Better Claims RFP Tactical Questions

• ContractsTermsTermsVendor Flexibility

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Building A Better Claims RFP Consequences in Conclusion

• Lack of Preparation ConsequencesNot All TPA’s Are Created EqualNot All TPA s Are Created EqualPlan

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Building A Better Claims RFP

Thank You !

A Better Claims RFPBUILDING

Alternative Service Concepts, L.L.C.