Description: The presenters will provide insights into fraud and abuse risk in the health insurance industry, including an examination of traditional and predictive modeling techniques for both prevention and detection. Emphasis will be placed on current and emerging risks. Canadian examples and perspectives will be offered, but the applications for attendees to use in practice are non-nation specific.

Description: The presenters will discuss predictive analytics as applied to recent group life and disability experience studies and other applications.

Description: First dollar carriers, stop loss carriers, and reinsurers play a different role in reimbursing healthcare claims. This article explores the reinsurer's role in reimbursing COVID-19 related claims.

Description: This report examines lapse experience on individual disability income insurance products by various policyholder and product factors. The study can be used for industry benchmarking as well as for background information for product development and planning purposes.

Description: Methods and assumptions used in the valuation of savings by external care vendors

Description: ACA risk adjustment has now been in play for years. The original intent of risk adjustment was to help stabilize the market through measuring risk levels of each issuer. However, the risk adjustment program may have introduced additional uncertainty due to annual market shifts and model changes, making risk adjustment estimation is a difficult task. This article analyzes the results over time, including impacts from market changes and model changes.

Description: The Individual Disability Experience Committee (IDEC) of the SOA has gathered industry data covering 2006-2015. The presenters will highlight findings on the recent industry experience compared to the 2013 Individual Disability Income Valuation Table (2013 IDIVT), including the impact of the recession on incidence and terminations. They will cover claim incidence and claim termination Actual to Expected (A/E) using 2013 IDIVT as the expected basis. The adequacy of the modifiers will also be discussed.

Description: The presenters will cover the variation in risk adjustment approaches used across state Medicaid programs and compare them to other Federal programs. Additionally, recent developments, such as the use of OCR to extract data from medical charts for risk adjustment, will be discussed.

Description: Actuarial Perspectives on COVID-19: June 10 Twitter Chat with the Society of Actuaries