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Tillit’s consultants have assisted numerous health plans and insurance companies with their health care actuarial needs. We work with finance, underwriting, provider contracting, regulatory compliance, medical management, and information services staff with issues such as: - Actuarial premium rate certifications,
- Small group compliance certifications,
- Unpaid claim reserving assistance and actuarial certifications,
- Health care trend analysis and trend projections,
- Benefit plan adjustment analyses,
- Provider contract analysis and contract negotiations,
- Development of risk sharing arrangements,
- Risk adjuster analyses,
- Provider profiling,
- Large case underwriting assistance,
- Underwriting and rating methodologies for the small and large group markets,
- Evaluating the effectiveness of medical management programs,
- Health care economic analyses,
- Evaluation of reinsurance arrangements,
- Stop loss pricing and reserving assistance,
- Analytical report design and/or “bridge” reporting assistance,
- Merger and acquisition support services.
In addition to assisting clients with ongoing actuarial needs, we can assist through an actuarial review of operations. An actuarial review of operations can be tailored to your organization and may include reviewing: - the IBNR reserve setting process,
- the soundness of the actuarial rate development process,
- underwriting rules and methods,
- the integration of provider contracting activities and trend forecasting.
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