Medical Benefit Claims Monitoring

The Commonwealth of Kentucky, Personnel Cabinet/Department of Employee Insurance is seeking a vendor to monitor medical benefit claims for the Public Employee Health Insurance Program. The vendor will be responsible for analyzing 100% of medical invoices or claims submitted for payment to the KEHP, identifying errors, and negotiating with KEHP Contracted Entities to resolve errors. The vendor will also provide quarterly reports to the Personnel Cabinet and the Legislative Research Commission. The contract will be awarded based on a comprehensive evaluation of proposals, including technical proposal, cost proposal, and oral presentation/demonstration. Key aspects of the job include: * Analyzing medical benefit claims to validate accuracy and identify errors in near real-time * Identifying and correcting errors to avoid erroneous overpayments * Identifying underpayments made by KEHP Contracted Entities * Identifying inappropriate or erroneous fees imposed by KEHP Contracted Entities * Providing quarterly reports to the Personnel Cabinet and the Legislative Research Commission * Negotiating with KEHP Contracted Entities to resolve errors