Austin, Texas, United States
I'm an experienced actuary at Texas Department of Insurance. I help out with financial examinations and try to figure out which companies will go insolvent before it happens. It's a challenging problem and it's fun having this big picture perspective and working with colleagues at peer regulators. I spent over twenty years in health insurance, at Blue Cross Blue Shield plans, regional HMO's, international health insurers, and now the regulatory side. If you're curious about actuarial careers in government or regulatory work, I'm happy to share what I've learned.
• Rate Development • Financial Projections • Trend Analysis
• Regulatory Examinations ◦ Performs actuarial examinations of life & health insurance companies ◦ Reviews actuarial opinions, supporting reports, & related analyses ◦ Performs analysis of proposed regulation, legislation, etc.
Chief Actuary (effective June 2018) Actuary Manager (effective April 2017) Regional Actuary (effective November 2016) November 2016 - Present • Manage or perform all actuarial functions after departure of Chief Actuary & actuarial analyst • Directed staff of five in Miami and four in Mexico City • Pricing ◦ Perform semiannual rate review & rate implementation ◦ Price new products for joint ventures in Brazil & Colombia ◦ Reconcile model inputs to ledger & income statement ◦ Trained & managed team in Mexico to price experience rated groups ◦ Maintain quoting tools for community rated groups • Reserving ◦ Estimate reserves for health & life products • Regulatory and Compliance ◦ Support external audit ◦ Improve Solvency II compliance for Latin American business units & Brazilian subsidiary ◦ For 2016 year-end, managed consultants for Statement of Actuarial Opinion & Actuarial Memorandum ◦ For 2017 year-end, served as Appointed Actuary for Bupa Insurance Company of Florida Associate Actuary, Pricing April 2015 - October 2016 • All tasks related to pricing function
Claims Reserving (Valuation) October 2012 - March 2015 • Estimated claims reserves for commercial and retiree medical plans ◦ Applied loss-ratio techniques, financial projections, and paid claim development models ◦ Designed, automated, and documented reports and analytic processes ◦ Worked across departments to identify emerging issues and performed ad hoc analyses • Designed & implemented process to forecast catastrophic claims from clinical data • Prepared actuarial opinions & memoranda for senior actuaries Reimbursement Analysis March 2012 through September 2012 • Performed analysis of unit cost growth to support trend assumptions • Overhauled existing process to improve accuracy, speed, and efficiency • Documented & streamlined processes • Trained junior staff & implemented succession plan Trend Analytics March 2009 through February 2012 • Developed rating trends • Performed analysis of historical medical expenditures ◦ Researched and explained key drivers of trend growth ◦ Reported on effectiveness of medical management programs • Developed forecasts of future medical expenditures ◦ Explained forecast variance in terms of potential business scenarios • Documented & streamlined processes • Trained junior staff & implemented succession plan
Performance Analytics March 2008 through March 2009 • Supported corporate initiative on healthcare cost & quality transparency ◦ Led analysis of chronic conditions to report costs to members ◦ Worked with external provider quality reporting groups to validate data ◦ Supported provider profiling initiatives Provider Contracting Analysis - Competitive Discount Reporting December 2006 through February 2008 • Researched discounts negotiated between providers and competing healthcare plans ◦ Leveraged existing sources of information to derive competitors’ fee schedules ◦ Developed data entry tool in MS Access to increase speed & accuracy ◦ Directed staff of 3-6 data entry personnel ◦ Reported discount advantage by provider and service type to inform contractors ◦ Reported financial benefits of achieving discount parity or advantage Provider Contracting Analysis - Network Tools & Reporting May 2006 through November 2006 • Modeled reimbursement for physicians in Utah ◦ Researched & documented claims process • Developed reimbursement budget model to support negotiation and manage rate increases Provider Contracting Analysis - Negotiation Support & Analytics Team February 2005 through April 2006 • Modeled reimbursement for physicians in Washington state ◦ Researched and documented how claims are adjudicated and priced ◦ Reviewed actual versus expected physician payment to identify implementation issues • Reviewed pricing models and assisted with rating dental plans