Description: Risk adjustment in government regulated health plans has been around for over two decades. Yet the strategies for promoting risk score accuracy haven't varied much during that time. Most health plans, physician groups, and vendors promote chart reviews and/or in-home assessments as the primary vehicle for collecting data not perceived to be present in the routine claims submission and adjudication stream. We know that most organizations trying to coalesce encounter data from multiple sources often fail to ensure that all relevant data is ultimately submitted to CMS or a state Medicaid agency. Crucial data, often with significant financial value, frequently gets lost in the data pipeline, somewhere between the provider's billing system and the health plan and/or its vendors. Because 837-formatted data is difficult to read, it complicates payers and vendor’s abilities to track encounter data so that every service delivered to patients is credited to the applicable risk adjustment formula. It is incumbent upon successful risk-adjusted entities to be able to track encounter data, identify processes and/or vendors which may be mangling or losing data, in order to ensure that risk scores are sufficiently accurate to be compliant with plan sponsor requirements and to ensure appropriate revenue to the health plan or provider group.

Description: This paper reviews the applications of operations research methods in the insurance industry. From Transactions of Society of Actuaries 1995, Vol. 47.

Description: This is a discussion about computer models and simulation tools for life insurance companies. From Transactions of Society of Actuaries 1969, Vol. 21, No. 59AB

Description: Ever wanted to do a Kaggle data science competition, but didn't know where to start? This presentation meets the needs of actuaries interested in predictive analytics and competitive data science. The presentation will describe the nature of competitive data science, and provide insights into lessons learned by competing in the Airbus Ship Detection Challenge at Kaggle, as well as other Kaggle competitions. The presenters will provide an introduction to neural networks and describe the nature of the Airbus Ship Detection Challenge and other Kaggle competitions, plus a solution approaches that can be used to obtain top scores using Convolutional Neural networks (CNNs), random forests and boosted trees.