Actuarial Services

Creating financial transparency

Health plans, employers and their advisors face a variety of challenges. These include evaluating and estimating uncertain risks, accurately predicting health spend, and reducing total cost of care. Addressing these challenges requires insight, innovation and collaboration.

We provide actuarial services, software and analytics tools to commercial, Medicaid, Medicare, ACA and pharmaceutical organizations. We specialize in the following offerings.

Government payers

• Reporting and analytics 
  • Risk adjustment and financial modeling 
  • Medical claim expense and pharmacy financial forecasting 
  • Medicare Part D expense forecasting and modeling
• Rate filings and bid submission
  • End-to-end Medicare product design
• Medicaid services 
  • Ongoing state rate negotiation support 
  • Rate adequacy development 
  • Risk adjustment analytics support 
  • Claims data analytics and support for regulatory submission and compliance functions

Commercial payers

• Benefit design actuarial pricing model
• Specialty benefit actuarial services, e.g., dental, etc.
• Underwriting support using social determinants of health and predictive modeling
• Employer group creditable coverage and RDS attestation support
• Cloud-hosted underwriting risk assessment solution delivering prospective group health risk scores in minutes, with Group Risk Analytics

Pharmacy

• Specialty and orphan drug actuarial modeling support
• Medicare Part D strategic and educational support for life science companies
• Unit cost and drug pricing analytics support for life science drug companies

Trend analytics

• Actuarial services supporting detailed understanding of medical and pharmacy trend drivers
• Ongoing monthly reporting services to analyze and monitor trend patterns