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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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Small Talk, December 2018, Issue 50
and other topics. Health insurance and long-term care insurance have their own pages. The organization ... change as well. The mom-and-pop approach to customer care will also slowly lose its appeal as the new generation ...- Authors: Society of Actuaries
- Date: Dec 2018
- Competency: 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: Small Talk
- Topics: Technology & Applications>Analytics and informatics
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The Modeling Platform
into the map. Manual items often require special care and con- sideration in effective model management ... and other indirect experience items as well as direct application of profes- sional judgment to assumptions ...- Authors: Society of Actuaries
- Date: Apr 2016
- Competency: Professional Values>Practice expertise; 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: The Modeling Platform
- Topics: Actuarial Profession>Best practices; Actuarial Profession>Competencies; Enterprise Risk Management>Governance; Enterprise Risk Management>Operational risks; Life Insurance>Policyholder behavior - Life Insurance; Life Insurance>Universal life; Modeling & Statistical Methods>Deterministic models; Modeling & Statistical Methods>Modeling efficiency; Modeling & Statistical Methods>Scenario generation; Modeling & Statistical Methods>Stochastic models; Technology & Applications>Software
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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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Understanding ORSA: Risk, Solvency and Beyond
individual insurers writing at least $500 million in direct written and nonaffiliate assumed premium are subject ... insurance groups writing at least $1 billion in direct written and nonaffiliate assumed premium are also ...- Authors: Elisabetta Russo, Lee H Resnick, Jacky Kwan
- Date: Jan 2014
- Competency: 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: Health Watch
- Topics: Enterprise Risk Management>Risk appetite; Enterprise Risk Management>Risk categories; Enterprise Risk Management>Risk measurement - ERM; Finance & Investments>Risk measurement - Finance & Investments
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rm-2017-iss-40-harwood
that are familiar to managers and that help them direct effort to achieve the desired result. Can this ... THE FIRM? Behemoth seeks edgy other to join crazy care of customers, never sleeping, continually creative ...- Date: Dec 2017
- Competency: 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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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