Actuary
CurrentDesign, implement and maintain provider cost models and perform provider finance analyses. Prepare rate filings and pricing of new products for healthcare insurance coverage. Prepare Medicare Bids as required by CMS; capitation and calculations for premiums; trend analysis and profitability studies on various groups, revaluate various rating factors. Develop financial tools to evaluate the appropriateness of corporate claims reserve levels. • Credited with developing a procedure allowing Paramount to arrive at new rates in a matter of minutes• Developed a method to calculate the reserves regarding part D• Determined what enrollees’ risk scores were declining from one year to the next year for case management to follow-up with the coding process. This process helped to obtain millions of dollars of additional revenue from CMS• Worked on a team to develop and price new products to bring out to the market such as PPO, CDHP and Medigap and Medicare select insurance.• Analyzed how different regulations would impact the cost towards the company and in return how much additional premium would need to be charged to the policy holders.
