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

Description: This article provides a brief overview of the current state of machine learning (ML) and artificial intelligence (AI) as they apply to actuarial science, including discussion around the integration of actuarial judgment with ML and AI. It concludes with an example of explainable ML through a python tool known as SHAP (SHapley Additive exPlanations), which is able to explain the key drivers behind individual ML or AI predictions.

Description: The reinsurance market is experiencing unprecedented growth in both frequency and severity of catastrophic medical claims. Most experts identify specialty drugs, new gene therapies and high-intensity hospital in-patient stays as contributing factors. With Rx claims, high-cost drug protocols are creating chronic high-cost cases over multiple years. What can actuaries do to rapidly identify these cases? If identified, what techniques can be used to reduce or manage cost? Panel will include a nationally recognized consulting actuary, health plan executive and reinsurance executive.

Description: The April/May 2013 edition of The Actuary magazine—the Society of Actuaries’ flagship publication.

Description: This session will explore the national landscape of state Medicaid risk adjustment program design & application and the key differences that drive effective managed care organization program management. Risk adjustment is a mechanism to adjust capitation rates between Managed Care Organizations to account for population morbidity differences. Although many states utilize this mechanism, the application of risk adjustment can vary significantly across states. The primary differences include populations, risk score models and data collection. These state application nuances affect the strategies and tactics utilized by MCOs for effective risk adjustment program management including provider financial alignment, encounter data submission and the capture of accurate diagnosis codes. The session is intended for Medicaid Managed Care Actuaries working to develop or support comprehensive risk adjustment program management functions.

Description: Interview of people knowledgeable about risk adjustment and the use of social determinants of health with that context for Medicaid.

Description: 1993 SOA Spring Meeting, San Diego. This session is about point-of-service plans, overview of current enrollment statistics/ tends, in-network and out network utilization patterns, trends in benefit design, employer/benefit consulting demands and employee/employer satisfaction.

Description: Regulatory change and increased focus on internal risk management are driving a renewed interest in model efficiency. In this session, we will review several new and existing tools, that show significant promise for advanced modeling of equity linked products. These include: • Clustering • Use of unique--and potentially a different number of--scenarios for each policy • Semi Monte Carlo (SMC) – this is a proprietary technique that is similar to a combination of Monte Carlo and numeric integration • Using a neural network approach to optimize some of the more complex and manual aspects of clustering and improve the fit of the clustered model • Combining SMC with the use of unique scenarios per policy

Description: 2004 SOA Spring Meeting, Anaheim, CA. In this session panelists presented an overview of underwriting processes for a variety of product lines. They also discuss related topics such as identifying keys to underwriting decisions, the cost of underwriting and protective value, and ensuring consistency with pricing assumptions. Some of the underwriting tools discussed were use of RX history, credit checks, DMV history, and fraud data bases.

Description: Learn industry best practices including challenges faced by retirees, such as needing exposure to growth, most exposed to sequencing risk, and the need for smooth returns to avoid poor investor behavior caused by risk aversion. Other topics will include how to set investment objectives which consider the members’ real-world needs and how to build portfolios and implement risk management strategies to meet those objectives. The speaker will provide real-life examples/case studies.