Insurance & Actuarial Services

Actuarial Services

PRIVATE SECTOR & CORPORATE EMPLOYERS

Bates Group brings together a team of diverse industry and technical experts skilled in designing more efficient safeguards from an enterprise’s risks (which we define as two broad categories that range from those associated with the company’s employees to those exposures relating the business of the company). Our consulting actuaries and risk management specialists will gauge a company’s risk appetite with their want or need for protection. Using a holistic risk review process that properly reflects the nuances of the organization, a comprehensive analysis produces a risk mitigation glide path that prioritizes risk rebalance. The outcome is alignment between the company’s decision making processes and the right amount of protection for an appropriate cost and a balance sheet better protected to absorb risk volatility from these risk exposures.

Risk Category #1: Employer Related Risk Exposures:

Workers Comp, General Liability, Professional Liability, Hazard, Esoteric, Business-focus risk exposures typically ‘self-insured’ (whether on purpose or by chance) include the likes of: cyber risk, environmental impairment, business interruption, political risk, product recall, etc.

Risk Category #2: Employee Related Risk Exposures:

Retirement, Pension, Executive Comp, Healthcare, Wellness, Voluntary, Fringe & Flex Benefits, which covers group medical, dental, disability, life insurance, drug plans, etc.

Our consultants also provide expert support across these two risk categories:

Employer Risk Focus:

Financial Report/Planning:

  • Valuation of loss contingent themed balance sheet values
  • Perform claim liability (IBNR) reserving studies – including scenario testing [stochastic simulation perspective]
  • Project loss reserve levels and risk forecasts
  • Evaluate loss adjustment expense (LAE)

Funding / Minimize Loss Cost:

  • Analyze past claims/loss experience
  • Evaluate customized mitigation methods
  • Project short and long term cost of risk
  • Evaluate alternative risk methods, like the formation of a captive insurance company

Employee Risk Focus

Financial Report/Planning:

  • Prepare valuations & disclosures for:
    • Defined Benefit pensions plans
    • Post-Retirement Benefits
    • Post-Employment Benefits/OPEB
  • Construct forecast simulations to understand funding ratio probabilities
  • Advise on de/re-risking strategies

Funding / Minimize Loss Cost:

  • Implement wellness programs
  • Evaluate innovative plan designs to lower costs of medical & drug benefits
  • Affordable Care Act navigation (strategies on Cadillac tax)

 

COMMERCIAL INSURANCE & REINSURANCE SECTOR & CORPORATE CAPTIVES

The Bates network of actuarial consultants is trusted by many of the industry’s leading life, health and P&C insurance and reinsurance companies, insurance regulators, accounting firms, law firms, agencies and brokers to assist with litigation and consulting engagements. Across the broader insurance space, our actuarial consultants focus by type of risk underwritten by the insurance company. Specifically, the insurance practice segments into the following cornerstones:

  • Life / Annuity (Term, WL, UL, ULSG, VA, PPLI, PPDA)
  • Health / Managed Care (Medical, LTC, Med Sup)
  • Property / Casualty (WC, PL, GL, Med Mal)
  • Reinsurance / Captives (On- and Off-Shore)
  • Ins. Linked Investments (Longevity, Catastrophic, Life Settlements)

Our actuaries have clients ranging from insurers to marketing organizations to third party administrators to investors exploring the earmarking of capital for this space. Those assignments include:

  • Expert Witness and Litigation Support
  • Financial Reporting under Statutory, Tax, GAAP, and IFRS
  • Insurance Regulation and Governance
  • Merger, Acquisitions and Restructuring
  • Appraisal Services and Due Diligence
  • Product Development and Assumption Setting
  • Market Analysis
  • Compliance and Product Filings
  • Economic capital
  • Illustration and Dividend Actuary
  • Reinsurance Assessments and Audits
  • Administrative and Valuation Systems Conversion Support
  • Cost Driver Analysis
  • Audit Support and Examination Planning
  • Excess Insurance Evaluations
  • Underwriting Policies and Claims Operations
  • Self-Insurance and Captive Studies
  • Claims Liability

 

HEALTHCARE SECTOR PROVIDERS, PAYERS, AND RELATED STAKEHOLDERS

The Bates Group has contracted with a well known group of actuarial consultants that regularly service the needs of the two core healthcare market participants as well as an overarching number of specialty sub-practices. Generally, the bifurcation occurs between healthcare payors (insurers and health plans) and healthcare providers (hospitals, ACOs, etc.) with each category having the following services:

HEALTHCARE PROVIDERS

Strategy Focus:

  • Developed & evaluated business model for inefficiencies
  • Constructed financial forecasting and capital budgeting models
  • Prepared a matrix of pros/cons of short and long term strategies
  • Due diligence – valuation of targets, deep dive into “risks”
  • Developed models to assess narrow network opportunities on the ACA Exchanges

Optimize Margins Focus:

  • Designed & tested effective compensation & income frameworks
  • Evaluated then improve results-driven physician incentives
  • Assessed & enhanced risk sharing programs
  • Analyzed and advise on improvements for reimbursement, network contracting, and fee schedules
  • Drilled into cost drivers, unit costs & utilization norms and key performance indicators
  • Assessed macro & micro capitation frameworks
  • Built quality, cost, and contract models

Manage Claims Focus:

  • Developed robust loss reserving analysis for management reporting
  • Evaluated solutions that improve outcomes (morbidity to longevity)
  • Constructed sophisticated predictive models

HEALTHCARE PAYORS

Strategy Focus:

  • Developed & evaluated Form A newco business models
  • Performed competitor & market studies
  • Evaluated and negotiated reinsurance agreements
  • Due diligence – valuation of targets, deep dive into “risks”

Financial Reporting Focus:

  • Produced Actuarial Certifications and Annual Statutory Opinion
  • Developed robust (stochastic) medical/Rx IBNR (IBNP) studies
  • Performed claims expense study to support LAE
  • Developed ACA risk corridor calculations (refunds, rebates, reinsurance)
  • Prepared models for premium deficiency reserve testing

Rate Filing Focus:

  • Prepared and filed Medicare Adv./Rx Plan CMS Bid Submissions
  • Prepared and filed Medicaid Rate Certifications
  • Prepared and filed HMO Certificate of Authority (COA)

Ratemaking & Plan Design Focus:

  • Constructed from simple to comprehensive rating algorithms
  • Developed rate manuals for many benefit designs
  • Constructed sophisticated predictive models

Contact Bates Group

Bates Group is with you every step of the way. Contact us today for more information on how our End-to-End Solutions can help your firm.

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Insurance & Actuarial Services

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