Specifications include, but are not limited to: The Department is contracting for this position to assist in the reflective regulatory examination (continuum) process of health insurance companies that the Department regulates and that are authorized to transact the business of insurance in the Commonwealth of Kentucky. More specifically, this position will be responsible for assisting Department staff in the development of examination plans, reviewing, interpreting, and analyzing medical and billing records, compiling and organizing medical records and data pertaining to health care provider claims for reimbursement, translating medical terminology, and assisting in the evaluation of Company practices in the application of the Kentucky Insurance Code within the market conduct examination (continuum) process. The Department schedules market conduct examinations (continuums) when deemed necessary. This position shall assist in the preparation of a detailed examination report for each regulated entity or person examined. The written report shall comply with the minimum requirements set by the Department in regard to content, thoroughness, and format. The Consultant may be required to testify in formal proceedings that may result from examinations. An eligible Vendor is one who is competent and has the necessary education, experience, and special training to perform the responsibilities of a Consultant. Only those Vendors qualified as stated below shall be eligible for a Contract to perform the services as an Examiner. Health Insurance Consultant – The Health Insurance Consultant shall assist the Chief Examiner in the adjudication of health insurance regulatory actions. Advanced knowledge of ICD/CPT medical terminology is expected.
