Description: Level funded products often target the small group market (2-50) and can result in many manual and tedious processes for underwriting to perform risk assessment. Learn how a carrier used technology to help automate risk assessment without the need for paper medical questionnaires, and exposed a risk engine for broker quoting to enable near real-time of pricing for risk-based products. The approach reduced labor and allowed underwriting to focus solely on fallout cases while also improving pricing consistency. Discuss broader trends in the health market for risk assessment, including new machine learning cost predictions that can be used for automation and better predictions of future costs. Discussion topics will include underwriting guidelines, business rules, risk scores, and machine learning. By attending this session, you will have a better idea of new trends in risk assessment for small groups where no claims experience is available. And, better understand business rules that are common in underwriting for flags for review as well as how risk scores and machine learning can be used during the underwriting process.

Description: Electronic Health Records, or EHRs, are a major worldwide initiative to eliminate paper recordings – including Attending Physician Statements (APSs) – of an individual’s medical history and current treatment.

Description: This section presents book reviews and summaries of recent publications on a variety of topics.

Description: This document is a Request for Proposal (RFP) issued by the SOA Research Institute, seeking researchers to assess the impact of artificial intelligence on the insurance and healthcare industries in Asia, with specific research objectives, proposal requirements, selection process, submission guidelines, and appendix providing cost estimates.

Description: This study would assess the impact of recent patient care innovation(s) on health care and the health insurance industry.

Description: Read this report to learn more about interpretable machine learning techniques for health insurance fraud detection.

Description: 2021 Life Meeting - Session 5F: Premium Leakage - How Outdated Claims Systems are Losing You Money 8.31.21 Recording

Description: Telehealth enables the delivery of health care services to patients that are not in the same location as providers. Over the past decade, telehealth has been used increasingly to complement face-to-face patient encounters, and is particularly important to addressing health care needs in rural areas. Recent regulatory catalysts, particularly in the Medicare Advantage program, have served to elevate the visibility and importance of telehealth in the overall health care delivery system. Starting in 2020, Medicare Advantage plans can offer any clinically appropriate physician services through telehealth as part of the standard Medicare benefit. Network adequacy standards can also be met via telehealth providers under certain programs. This presentation will cover the basics of what constitutes telehealth, and provide tangible demonstrations of telehealth technology (simulating variations mediums through which services are delivered). We will cover the what, the why, and the where (anywhere) of telehealth in 2020.

Description: 1999 SOA Annual Meeting, San Francisco. Presenters discussed ways in which nontraditional methods of distributing insurance products are continuing to evolve and offered their views on where that evolution may lead for the industry.

Description: Discuss various analytics and use cases using payer published reimbursement contract data under federal mandate of Transparency in Coverage. These contract rates are publicly available in machine readable format (MRF) starting July 1, 2022, and refreshed monthly. By attending the session, you will have a better understanding of the state-of-art development and analytics using MRF data, including the technologies used to extract and analyze huge MRF files, validation and limitations of published rates, and their use cases.