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#18-005479-0022
Supplemental Questionnaire

Last Name
First Name
1.

Describe your experience in third party claims administration.  Include employer, job title, job duties, dates of employment and number of hours worked per week.  If no experience, indicate N/A.

2.

Describe your experience in  workers' compensation claims management.  Include employer, job title, job duties, dates of employment and number of hours worked per week.  If no experience, indicate N/A.

3.

Describe your experience in drafting and/or evaluating Requests for Proposals (RFPs).  Include job title, employer, duties, dates of employment and number of hours worked per week.  If no experience, indicate N/A.

4.

Describe your experience participating in and managing the RFP evaluation process.  Include employer and dates of employment.  If no experience, indicate N/A.

5.

Describe your experience monitoring and evaluating vendors in contract performance.  Include employer and dates of employment.  If no experience, indicate N/A.

6.

Describe your experience in managing all aspects of third-party claims administration and/or workers' compensation claims management.  Include job title, employer and dates of employment.  If no experience, indicate N/A.


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