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Validating a Novel Health Insurance Fraud Detection Method
Validating a Novel Health Insurance Fraud Detection Method This article describes methodologies ... Health care fraud;Predictive modeling;Medicare;Health insurance;Health economics;Health care costs;Data ...- Authors: Robert D Lieberthal, Elias
- Date: Aug 2018
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Economics>Health economics; Enterprise Risk Management; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Public financing - Health & Disability; Modeling & Statistical Methods>Data mining; Predictive Analytics
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Risk Management, August 2018
2017 Actuarial Research Conference (ARC) on health care fraud detection. In the March issue of Risk Management ... health insurance fraud detection method. This health care fraud study aims to develop a pro- phetic modeling ...- Authors: Society of Actuaries
- Date: Aug 2018
- Competency: Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Enterprise Risk Management
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Risk Management, March 2017
Offi- cer, Application of ERM National Long-Term Care Needs and Parameter Uncertainty. Finally, be on ... have a clearer picture of the future of health care. Brexit will eventually get moving along. Teresa ...- Authors: Society of Actuaries
- Date: Mar 2017
- Competency: Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Enterprise Risk Management
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A Review of Root Cause in Insurer Insolvencies and Impairments
liability; Life & Annuity, Health, including long- term care (LTC); and Health cooperatives. Figure 1 Number ... circumstances. Some insurer insolvencies point to one primary causal driver, such as fraud. However, a majority ...- Authors: David Heppen, Veronika Cooper
- Date: Aug 2018
- Competency: External Forces & Industry Knowledge>External forces and business performance; External Forces & Industry Knowledge>Internal forces and business performance; Professional Values>Practice expertise; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Enterprise Risk Management>Operational risks; Enterprise Risk Management>Risk measurement - ERM; Finance & Investments>Investments
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The Complications of Cyber Risk Quantification
set of losses associated with cyber attacks…The direct revenue losses for the companies involved in a ... unlikely. Alli- anz’s Donavan sees a “standard of care” evolving along the lines of the National Institute ...- Authors: Society of Actuaries
- Date: Mar 2017
- Competency: Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Enterprise Risk Management
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Addressing climate change belongs in the insurance companies
mitigation sides. The study has revealed that eight primary factors hinder the expansion of market- based ... of 21 primary insurance and reinsurance companies around the world. These included twelve primary insurers ...- Authors: Maryam Golnaraghi
- Date: Aug 2018
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>External forces and business performance; Leadership>Change management; Leadership>Influence; Leadership>Professional network leverage; Leadership>Thought leadership; Strategic Insight and Integration>Effective decision-making; Strategic Insight and Integration>Influence decisions; Strategic Insight and Integration>Strategy development; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Enterprise Risk Management
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Trifurcation: An Approach to Analyzing the Impact of Risk Treatment Alternatives
we can associate the middle tranche with the primary objective of the risk management activity. The ... effects on volatility and estate outside the primary objective. The first example will be a stock ...- Authors: Daniel Bar-Yaacov, David Ingram
- Date: Apr 2012
- Competency: Strategic Insight and Integration>Effective decision-making; Strategic Insight and Integration>Influence decisions; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Enterprise Risk Management>Financial management; Enterprise Risk Management>Portfolio management - ERM; Enterprise Risk Management>Risk measurement - ERM
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How to Turn Suspects Into Prospects
How to Turn Suspects Into Prospects By Ray Mascola Communication;Operational Management;Time ... priorities. By actively listening you show that you care and in the process you develop credibility and trust ...- Date: May 2017
- Competency: Communication>Active listening; Communication>Difficult message delivery; Communication>Oral communication; Communication>Persuasive communication; Communication>Written communication; External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance; External Forces & Industry Knowledge>General business skills; External Forces & Industry Knowledge>Internal forces and business performance; Leadership>Change management; Leadership>Influence; Leadership>Mentoring; Leadership>Professional network leverage; Leadership>Thought leadership; Professional Values>Ethical standards; Professional Values>Practice expertise; Professional Values>Public interest representation; Relationship Management>Relationships and trust; Relationship Management>Staff management and motivation; Relationship Management>Team leadership; Results-Oriented Solutions>Actionable recommendations; Results-Oriented Solutions>Assess decision effectiveness; Strategic Insight and Integration>Big picture view; Strategic Insight and Integration>Effective decision-making; Strategic Insight and Integration>Influence decisions; Strategic Insight and Integration>Management partnership; Strategic Insight and Integration>Strategy development; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Innovators & Entrepreneurs
- Topics: Actuarial Profession>Entrepreneurism; Actuarial Profession>Management skills; Actuarial Profession>Professional development
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Conversation with a CRO: An Interview with Lori Evangel
the U.S., Canada and Australia) and Long- Term Care (in the U.S.), and a company that has as its mission ... functioning as designed. As the CRO, I view my primary job as making sure that the pol- icyholders get ...- Authors: Anthony Dardis, Awa Kone
- Date: Aug 2018
- Competency: Leadership; Professional Values; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Enterprise Risk Management
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Letter from the Editor
2017 Actuarial Research Conference (ARC) on health care fraud detection. In the March issue of Risk Management ... health insurance fraud detection method. This health care fraud study aims to develop a pro- phetic modeling ...- Authors: Baoyan Liu
- Date: Aug 2018
- Competency: Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Enterprise Risk Management