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Validating a Novel Health Insurance Fraud Detection Method
Validating a Novel Health Insurance Fraud Detection Method This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for ...- Authors: Robert D Lieberthal, Elias
- Date: Aug 2018
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Economics>Health economics; Enterprise Risk Management; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Public financing - Health & Disability; Modeling & Statistical Methods>Data mining; Predictive Analytics
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Lending Expertise to Help Nonprofit Agency
Lending Expertise to Help Nonprofit Agency Details of an actuary’s project to help a local nonprofit agency improve its data analysis and customer service issues. Professional ...- Authors: Society of Actuaries, Roger Rosales
- Date: Aug 2014
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: The Actuary Magazine
- Topics: Health & Disability>Health care quality; Technology & Applications>Business intelligence
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Integrating Claims-Based and Survey-Based Data to Estimate Program Savings
Integrating Claims-Based and Survey-Based Data to Estimate Program Savings An approach to quantify medical intervention savings when medical claims data is not available by leveraging overlapping ...- Authors: Andrew Mackenzie, Ian G Duncan
- Date: Oct 2017
- Competency: Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Modeling & Statistical Methods>Estimation methods; Modeling & Statistical Methods>Regression analysis
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Design and Pricing of Tiered Network Health Plans
Design and Pricing of Tiered Network Health Plans This article discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment ...- Authors: Peter Horman
- Date: May 2009
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Economics>Health economics; Health & Disability>Health care quality; Modeling & Statistical Methods
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Estimating the Impact of Disease and Treatment on Life Expectancy
Estimating the Impact of Disease and Treatment on Life Expectancy Analysis of the impact of disease progression and treatment on life expectancy provides perspective on the long term costs to the ...- Authors: Tzu-Chun Kuo, Philipp Vetter
- Date: Jan 2011
- Competency: Leadership>Thought leadership; Professional Values>Public interest representation; Strategic Insight and Integration>Big picture view; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Demography>Longevity; Health & Disability>Health care quality; Health & Disability>Health risks; Modeling & Statistical Methods>Data mining