Scott's actuarial experience includes pricing, rating, reserving, regulatory filings, and expert testimony, and he has worked with Veterans Healthcare, Medicare, and Commercial populations.
Recent projects include:
Participating on a team developing the Department of Veterans Affairs Enrollee Health Care Projection Model. Leading enrollment projections, including special populations and eligibility (e.g., VA Choice & MISSION, combat Veterans, community vs. VA facility patient distributions, etc.)
Analyzing the impact of legislation and administrative policies on the VA’s integrated health care system
Estimating Incurred But Not Reported (IBNR) claim liabilities
Certifying actuarial assets and liabilities on insurance company financial statements
Developing revenue recognition models for ASC 606, including conducting analysis of policy persistency
Developing commercial exchange filings and consulting; testing mental health parity
Conducting Medicare Advantage bid development
Preparing commercial and Medicare Advantage medical loss ratio (MLR) filings
Leading the firm’s weekly internal call on ACA-related pricing, filing, and regulatory matters for two years
Publications and Presentations
ACA RADV for 2020 Year-End Financial Reporting (Society of Actuaries Health Financial Reporting Subgroup, December 2020).
Comparing health insurance company surplus levels (Milliman Insight, August 2020).
Health insurer balance sheets 10 years after ACA (Health Watch, June 2020).
Impact of Quality Improvement Activities on Medical Loss Ratio (Society of Actuaries Annual Health Meeting, 2019).
Risk-based Capital (RBC) (Milliman Health Forum, October 2018).
I’m the Appointed Actuary for the Orange Blank – Now What? (Valuation Actuary Symposium, August 2018).
Case Studies in Commercial Risk Adjustment Valuation (Society of Actuaries Annual Health Meeting, June 2018).
Reserving for Commercial Risk Adjustment Payment Transfers (Society of Actuaries webinar, December 2017).
Impacts of hurricanes on health outcomes and health insurance company operations (Milliman Insight, October 2017).
Medicare Advantage MLR: year two (Society of Actuaries Annual Meeting, October 2016).
Medical loss ratio and actuarial value: application to dental products (NADP CONVERGE, September 2016).
Related party considerations for Medicare bids (Society of Actuaries Annual Health Meeting, June 2016).
Medical Loss Ratio (MLR) in the “Mega Reg”: Medicaid adopts comprehensive MLR standards (Milliman Insight, June 2016).
Professional Designations
Fellow, Society of Actuaries
Member, American Academy of Actuaries
Education
MA, Mathematics, Statistics, University of Montana
How do for-profit and not-for-profit health insurers manage capital and surplus? We compare metrics such as the RBC ratio, net income, and growth of capital.
15 April 2024 - by Scott Jones, Chris Smith, Tabish Shaikh
REACH ACOs need to incorporate into financial projections another likely retrospective trend adjustment from the Center for Medicare and Medicaid Innovation.
We cover key considerations regarding Oregon’s Health Care Cost Growth Target program, including the potential financial and non-financial impacts for health plans.
27 June 2016 - by Jill Brostowitz, Scott Jones, Ian M. McCulla
While the Medicaid medical loss ratios (MLR) formula itself largely follows the commercial and Medicare Advantage (MA) MLR formula, there are key differences between the Medicaid minimum MLR standards and those currently established for the commercial and MA markets.
