Presenters

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Daniel W. Bailey, FSA, MAAA
Consultant

Daniel Bailey, FSA, MAAA, is a consulting health actuary in West Hartford, CT, and founder of Acumen Actuarial. He has over 25 years of experience in positions from actuarial student to AVP, VP and chief actuary. In addition to expertise in Medicare Advantage, his background includes both commercial health care and other government programs. He has worked with all group sizes and funding types, fully insured and self-funded, including small group, large group, federal government, state government and municipality plans. Bailey has many years of experience with government programs, such as Medicare Advantage, Medicaid, CHIP and high risk pools. He has developed and certified hundreds of Part C and Part D Medicare Advantage bids of all different types for many Medicare Advantage Organizations (MAOs) in the U.S. and its territories. Bailey has been involved with managed Medicare since the mid-1990s. He assists clients with Retiree Market strategies.

Bailey originally developed the SOA Boot Camp course in Medicare Advantage Pricing in 2009 and has led and taught it for the past six years. Bailey helps his clients with strategy, business reviews and feasibility studies, pricing and trend, product development, research and development, actuarial research and modeling, forecast and plan, financial reporting, rating systems, risk adjustment, predictive modeling, underwriting, reserving and valuation, provider analysis and market analysis. He has signed hundreds of rate filings in multiple states. Bailey has helped companies develop reporting that enables them to better understand the key drivers of their business performance and the risks underlying their contracts and enterprise. Bailey has also been involved with health reform. In addition to MAOs and other private health care payers, Bailey has worked with state governments, physician groups, hospital systems, and Accountable Care Organizations. He has analyzed existing regulations and proposed policy changes around essential benefits and mandates. Bailey has numerous publications and is a frequent speaker on health topics.

Kevin L. Pedlow, ASA, MAAA, FCA
Actuarial Consultant
Susquehanna Actuarial Consulting Inc.

Kevin Pedlow, ASA, MAAA, FCA, has over 20 years of experience as an actuary in health insurance, managed care and reinsurance. He has experience with HMOs, PPOs, indemnity insurance, Medicare Risk products, Medicaid products and Stop Loss. Pedlow has experience with strategic direction, pricing, financial reporting, setting and auditing claim and contract reserves, ACR filings and both the development and audit of MA-PD bids. Pedlow is a Fellow with the Conference of Consulting Actuaries, an Associate in the Society of Actuaries, and is a Member of the American Academy of Actuaries.


Optional Professionalism Lunch

Brian Edward Pauley, FSA, MAAA
Chief of Staff
Evolent Health

Brian Pauley, FSA, MAAA, is managing director at Evolent Health and is the chairperson of the SOA’s Health Section Council. As an active volunteer, Pauley is also chairperson of the SOA’s Group and Health Advanced Education and Examination Committee, and a member of the Group and Health Curriculum Committee. Pauley was also chairperson of the 2016 SOA Health Meeting.  Pauley has 14 years of experience in life and health insurance functions, primarily with the financial analysis and pricing of Medicare Advantage plans. He received a bachelor’s degree in mathematics, chemistry, and physics from the University of Southern Indiana, and a master’s degree in mathematics from the University of Louisville.

Karen Shelton, FSA, MAAA
Director of Private Exchanges
UnitedHealthcare

Karen Shelton is the director of Private Exchanges at UnitedHealthcare with 20 years of experience in the health care industry. She is responsible for strategic financial management, pricing tool development and actuarial research for this specialized block of business.

Shelton is passionate about educating current and future actuaries. She is actively involved in curriculum development for the Group & Health FSA track, serving as the financial economics module chair and as a prior curriculum general officer. She is also the current SOA Health Section Council Secretary/Treasurer and Health Boot Camp Chair. Shelton resides in Richmond, Virginia with her husband, Mark, their two young children, Hannah and Nathan, and dog, Manny.

Joseph L. Wurzburger, FSA, MAAA
Staff Fellow, Health
Society of Actuaries

Joe Wurzburger, FSA, MAAA, has been the Health staff fellow with the SOA since 2014. In this role, Wurzburger has a variety of responsibilities, including section development and support (specifically for the Health and LTC sections), actuarial practice advancement and thought leadership, exploration of growth opportunities for actuaries outside of traditional roles, internal SOA consulting, networking and leadership development, and actuarial knowledge development. In his most recent role prior to joining the SOA, Wurzburger managed the health valuation department in the Chicago office of Bankers Life, primarily focusing on long-term care insurance and Medicare Supplement. Prior to that, he filled a variety of actuarial roles in both consulting and insurance and has experience with pricing, valuation and projections.