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Medicare Advantage – Part C and some Part D Pricing Boot Camp

Daniel W. Bailey, FSA, MAAA

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, Bailey’s 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. He 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. Bailey has signed hundreds of rate filings in multiple states. He 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, he has worked with state governments, physician groups, hospital systems and Accountable Care Organizations. Bailey has analyzed existing regulations and proposed policy changes around essential benefits and mandates. He has numerous publications and is a frequent speaker on health topics.

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

Kevin Pedlow, ASA, FCA, MAAA, 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. He 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.

Professionalism Lunch

Brian Pauley, FSA, MAAA
Vice President, Actuarial Services
Highmark Health

Brian Pauley, FSA, MAAA, is the chairperson of Initiative 18|11, a joint endeavor of the SOA and Kaiser Family Foundation with the goal of developing actionable projects intended to lower the cost of health care in the U.S. As an active volunteer, he is also chairperson of the SOA’s Group and Health Advanced Education and Examination Committee, a member of the Nominating Committee and a member of the Group and Health Curriculum Committee. In addition to serving as chairperson of the SOA’s Health Section Council, Pauley was chairperson of the 2016 SOA Health Meeting. He is managing director at Evolent Health. Pauley has 15 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.

Douglas T. Norris, FSA, MAAA
Principal and Consulting Actuary

Doug Norris, FSA, MAAA, is a principal and consulting actuary with the Denver office of Milliman. He focuses on commercial health care considerations, including health care reform strategy and tactics, risk adjustment and predictive modeling, plan pricing, medical underwriting, contract and network negotiations, financial reporting and reserving, and interactions with managed Medicaid plans. Norris is an active participant in multiple commercial health research initiatives, including the current Society of Actuaries “Commercial Health Care: What’s Next?” Task Force. He is a past chair of the Society of Actuaries’ Predictive Analytics and Futurism Section.

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.