Description: This study would assess the impact of recent patient care innovation(s) on health care and the health insurance industry.

Description: Level funded products often target the small group market (2-50) and can result in many manual and tedious processes for underwriting to perform risk assessment. Learn how a carrier used technology to help automate risk assessment without the need for paper medical questionnaires, and exposed a risk engine for broker quoting to enable near real-time of pricing for risk-based products. The approach reduced labor and allowed underwriting to focus solely on fallout cases while also improving pricing consistency. Discuss broader trends in the health market for risk assessment, including new machine learning cost predictions that can be used for automation and better predictions of future costs. Discussion topics will include underwriting guidelines, business rules, risk scores, and machine learning. By attending this session, you will have a better idea of new trends in risk assessment for small groups where no claims experience is available. And, better understand business rules that are common in underwriting for flags for review as well as how risk scores and machine learning can be used during the underwriting process.

Description: The Society of Actuaries Research Institute commissioned this study to highlight the leading emerging technologies that may significantly affect the actuarial profession over a three-year horizon. This study will act as a guide and a resource for actuaries or potential employers to identify the prospective tools to enhance or expand actuarial work, for people collaborating with actuaries who may be affected by these technologies, and for leaders looking to enable teams employing actuaries through the introduction of these tools.

Description: Decentralized insurance alternatives is a rapidly expanding sector of Decentralized Finance (DeFi), an emerging and growing financial ecosystem powered by blockchain technologies. The purpose of this report is to review and discuss the business models and operating designs of decentralized insurance alternatives, which may have significant implications for traditional insurance businesses, as well as the actuarial profession.

Description: This session series is sponsored by Zelis Claim analytics produces valuable insights about provider cost, quality, and referral patterns. Provider networks can be created around high-value providers to improve clinical outcomes while lowering the cost of care. Programs to improve provider performance and/or incentivize members to choose high-value providers exist, but how do you bring all of this together to achieve desired outcomes? Join us to learn how to leverage provider level analytics to build and optimize a network with high-value providers at the center. Analyze the network for competitiveness and adequacy and demonstrate progress toward network cost saving goals to key stakeholders by modeling claim data for a member population. Finally, ensure the success of your network through an incentive program that shifts utilization to those high performing providers. By attending this session, you will be able to: - Build a realistic provider network with high-value providers at the center. - Evaluate the overall financial impact of network build and optimization efforts. - Learn about an innovative member incentive program.

Description: This session series is sponsored by Zelis Shifting utilization of health services to efficient and high-value providers presents an opportunity to reduce harmful cascades of wasteful spending, ultimately freeing up funds for additional high-value services that will improve quality and member satisfaction. Identifying the right providers to put at the center of networks is challenging for any health care organization. How can you objectively determine which providers are delivering the greatest value when compared to their peers? And once those providers are identified, what’s next? Join Zelis and their partner HealthCorum to review a case study on a shared services organization where they leveraged statewide multi-payer claims data to produce provider level analytics, allowing for transparency into provider practice patterns at a granular level. By attending this session, you will be able to: - Create a fair methodology to benchmark providers. - Develop metrics and scores to identify high-value providers. - Produce actionable data to be used for network optimization strategies.

Description: View the Avoiding Unfair Bias in Insurance Applications of AI Models

Description: As technology continues to improve, the actuarial profession is challenged by the tremendous potential benefits of new technology and the concurrent creation of new risks that accompany it. Technology should enable good work products that meet strict deadlines, deliver meaningful information to regulators and shareholders, and inform management teams about opportunities to develop our businesses. Answering questions about what technology we might use and how it can aid in making the best investment in our operations is key to making value proposition arguments to support the adoption of new technology in the workplace. Learn practical examples of automation as it's applied in actuarial practice, a potential composition of the actuarial toolkit and the business of managing the use of automation. Advance the state of your workplace art through several angles of this topic as: - Categories and purposes of several kinds of automation and supporting tools that might be used in actuarial practice - How management messaging and culture affects the way automation tools are used and how technical risks are managed - Implementing automation based on the presented case studies

Description: The supplemental health market is changing. Carriers are looking to simplify claims processes, proactively identify missed claim opportunities, and reduce barriers to claim payment. As a result, more and more companies are looking at ways to use data from medical diagnostic and treatment codes. Take an introductory look at the most used medical codes—ICD (9 and 10), CPT, and HCPCS. Discuss the history and purpose of each code system and decipher the structure. Dive into how medical codes can be used in the supplemental health market (automatic claims adjudication, fraud identification, pricing), as well as common pitfalls encountered when using medical coding. By attending this session, you will have a basic understanding of the different types of medical codes, their actuarial applications, and common pitfalls.

Description: Session 9B: Actuaries and Technology: Perspectives on Actuarial Workflow Automation The life insurance industry has experienced unprecedented growth in modernization efforts, with special attention paid to automating actuarial workflows. Companies are creating processes that are more scalable and maintainable, helping actuaries meet strict deadlines and deliver meaningful information to stakeholders. Discuss practical examples of automation, potential compositions of the modern actuarial toolkit, and different ways actuaries and technology teams interact during implementation and production states. Examine how automation can help actuarial teams shift from a quarterly to a monthly valuation process by overcoming challenges in traditional actuarial processes-long run times, the need for highly specialized legacy software skills, and inadequate control. Shifting to a monthly schedule can increase alignment on company objectives, deepen insurers' understanding of their business, and improve strategic decision-making. Leave with new ways of thinking about technology, from day-to-day best practices to full-scale actuarial transformation. By attending the session, you will: - Explain and understand the benefits of automating actuarial workflows with the purpose of operating on a monthly, rather than quarterly basis. - Describe the categories and purposes of several kinds of automation and supporting tools that might be used to accomplish this. - Understand different actuarial IT operating models and consider the application of such strategies at your organization. - Identify best practices for implementing automation based on the presented case studies.