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Validating a Novel Health Insurance Fraud Detection Method
Validating a Novel Health Insurance Fraud Detection Method This article describes methodologies ... Health care fraud;Predictive modeling;Medicare;Health insurance;Health economics;Health care costs;Data ...- 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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Risk Management, August 2018
2017 Actuarial Research Conference (ARC) on health care fraud detection. In the March issue of Risk Management ... health insurance fraud detection method. This health care fraud study aims to develop a pro- phetic modeling ...- Authors: Society of Actuaries
- Date: Aug 2018
- Competency: 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: Enterprise Risk Management
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What does ERM mean for Health Practitioners?
Why Care About Enterprise Risk Management? I n late 2008, the health insurance industry faced a number ... Garnett 10 New Member Impact on Medicaid Managed Care Costs By Bela Patel Fernandez and Jeff Smith ...- Authors: Max Rudolph
- Date: Feb 2010
- Competency: External Forces & Industry Knowledge>External forces and business performance; Relationship Management>Staff management and motivation; Results-Oriented Solutions; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management
- Publication Name: Health Watch
- Topics: Economics>Health economics; Enterprise Risk Management; Modeling & Statistical Methods>Forecasting
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A Framework for Pension Risk Management
as credit risk and longevity risk, could have a direct and meaningful impact on a plan’s current funding ... Additional plan risks exist beyond those whose direct impact is primarily financial, including those ...- Authors: David Cantor, Brett Dutton
- Date: Mar 2014
- Competency: Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management
- Publication Name: Risk Management
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A Review of Root Cause in Insurer Insolvencies and Impairments
liability; Life & Annuity, Health, including long- term care (LTC); and Health cooperatives. Figure 1 Number ... circumstances. Some insurer insolvencies point to one primary causal driver, such as fraud. However, a majority ...- Authors: David Heppen, Veronika Cooper
- Date: Aug 2018
- Competency: External Forces & Industry Knowledge>External forces and business performance; External Forces & Industry Knowledge>Internal forces and business performance; Professional Values>Practice expertise; 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: Enterprise Risk Management>Operational risks; Enterprise Risk Management>Risk measurement - ERM; Finance & Investments>Investments
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Risk Management, March 2017
Offi- cer, Application of ERM National Long-Term Care Needs and Parameter Uncertainty. Finally, be on ... have a clearer picture of the future of health care. Brexit will eventually get moving along. Teresa ...- Authors: Society of Actuaries
- Date: Mar 2017
- Competency: 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: Enterprise Risk Management
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Addressing climate change belongs in the insurance companies
mitigation sides. The study has revealed that eight primary factors hinder the expansion of market- based ... of 21 primary insurance and reinsurance companies around the world. These included twelve primary insurers ...- Authors: Maryam Golnaraghi
- Date: Aug 2018
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>External forces and business performance; Leadership>Change management; Leadership>Influence; Leadership>Professional network leverage; Leadership>Thought leadership; Strategic Insight and Integration>Effective decision-making; Strategic Insight and Integration>Influence decisions; Strategic Insight and Integration>Strategy development; 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: Enterprise Risk Management
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The Complications of Cyber Risk Quantification
set of losses associated with cyber attacks…The direct revenue losses for the companies involved in a ... unlikely. Alli- anz’s Donavan sees a “standard of care” evolving along the lines of the National Institute ...- Authors: Society of Actuaries
- Date: Mar 2017
- Competency: 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: Enterprise Risk Management
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Sustainable ERM
information management, alignment of interest, etc. Direct and officer liability and other commercial liability ... general public. It is the byproduct of taking care of other stakeholders. SERM goes beyond traditional ...- Authors: Fan Yang
- Date: Jan 2015
- Competency: Professional Values>Public interest representation; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management
- Publication Name: The Actuary Magazine
- Topics: Finance & Investments>Economic value; Pensions & Retirement>Risk management
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Conversation with a CRO: An Interview with Lori Evangel
the U.S., Canada and Australia) and Long- Term Care (in the U.S.), and a company that has as its mission ... functioning as designed. As the CRO, I view my primary job as making sure that the pol- icyholders get ...- Authors: Anthony Dardis, Awa Kone
- Date: Aug 2018
- Competency: Leadership; Professional Values; 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: Enterprise Risk Management