Services Provided and Project Approach

Adams Actuarial LLC is a health actuarial consulting firm providing high-quality services to payors, providers, employers, auditing firms, and other consulting firms. These services are provided timely, efficiently, and at competitive prices. Contact Jeff Adams at 585-300-6377 or email.

Services Provided

Adams Actuarial LLC provides health actuarial and underwriting consulting services to insurance companies, health maintenance organizations, health insurance funds, hospitals, physicians, vendors, employers, auditing firms, and consulting firms. Services include, but are not limited to, the following:

  • Premium Rate Calculation and Review
  • Hospital, Physician, and Vendor Contract Review and Impact Analysis
  • Financial Reporting, Forecasting, Reviews, Modeling, and Automation
  • Actuarial Methodology Reviews and Automation
  • Incurred But Not Paid (Claims Reserve) Review and Estimation
  • Underwriting Reviews, Methodology Reviews, and Automation Assistance
  • Actuarial and Underwriting Studies
  • Actuarial and Underwriting Department Organization Review
  • Actuarial Study Program and Staff Development
  • Temporary Actuarial or Underwriting Services for Understaffed Departments
  • Business and Strategic Planning
  • Health Care Reform
  • Employer Premium Rate Review
  • Postretirement Medical Valuation Review and Analysis
  • Research
  • Audit Support
  • Article or Report Writing

Listed below is a further categorization of these services:

Services Offered to Payors (Insurance Companies and HMOs):

  • Premium rate setting, including calculation of or review of community or experience rates and review of the rate-setting strategies and processes used, review of the claims and administration to ensure consistency between financial statement claims and administration. Inconsistencies periodically exist between rate assumption and financial statement assumptions leading to unexplained variances from budget
  • Review of hospital, physician, or vendor contracts for financial impacts
  • Review or production of financial information related to the financial statement, including accruals, budgets, forecasts, claims reserves (Incurred but not Paid accrual)
  • Review of methodologies and processes used in the actuarial and underwriting departments. Process changes within the department can help prevent “surprises” in all aspects of the company’s financial statement and premium rates
  • Studies such as claims seasonality by month and day. Costs are much less on Saturday, Sunday, and certain holidays than on weekdays. In certain parts of the country, claims will be significantly less on days with a substantial amount of snow
  • Actuarial or underwriting department organization or process review
  • Temporary services for excess workload or open positions
  • Assistance in business or strategic planning
  • Actuarial study program and staff development guidance

Services Offered to Health Care Providers and Vendors:

  • Actuarial review and analysis of financial arrangements and proposals
  • Actuarial accrual review and calculations
  • Assistance in incentive arrangement development and review
  • Strategic planning

Services Offered to Employers and Health Insurance Funds:

  • Assistance to health insurance funds in setting or reviewing premium rates, claims reserves (Incurred But Not Paid accrual), budgets, or strategies
  • Assistance to employer groups and other entities in reviewing premium proposals from insurance companies and managed care organizations
  • Postretirement benefits other than pension valuation and strategy review

Services Offered to Auditing Firms:

  • Review of insurance company or managed care organization actuarial accruals, including claims reserve (Incurred but not Paid), incentive pools, and post-retirement medical actuarial assumptions
  • Review of required actuarial accruals for self-insured and fully-insured experience-rated employer groups

Services Offered to Consulting Firms:

  • Assistance for excess workflow or in areas of needed expertise

Other Miscellaneous Services Include:

  • Research various health care, actuarial, underwriting, or math-related topics. This would include authoring of articles, reports, or books on this subject

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Project Approach

Our approach to any project is designed to deliver a timely product with quality results with output precisely that which the client desires. While performing work on a project, we also have an eye on the future by looking for ways to streamline the project and produce additional usable and helpful output for the client. There are many occasions where information produced during a project may lead to results that should be researched further in a direction originally not intended, if time permits. Our flexibility and wisdom to adjust the project make the results of the project more efficient and effective for the client.

Studies have shown that rework is 25% to 35% of work performed by companies during the course of a normal business day. We feel that the most important steps to a project may be before the actual work on the project even begins. Good planning and execution are essential to the completion of a quality product.

The first step will be to obtain knowledge of what is desired by the client in the project. This will involve conversations with you to determine your desires and get an idea of the current environment. We will also analyze possible future changes in the environment in which your company will operate over the next few years. Other ancillary conversations may also be necessary to understand the full scope of the project. We also will perform additional research during this step.

The planning stage will determine what steps are necessary to fully meet your objectives and produce a quality project. Deadlines will be set and adhered to. Note will be taken of any item that we will need from an outside entity. One of the ideas behind good planning is to get the project under our control as soon as possible by obtaining information from outside entities quickly and not waiting until it is needed. We think the phrase “I missed the deadline because I was waiting for information from…” is overused. Many times the situation could have been avoided with good planning, execution, and follow-up. Obviously, there are situations where waiting needs to necessarily occur, but we have found that many times these situations can be avoided.

The project plan will be shared with and developed in conjunction with you. The plan will contain deadlines that are necessary to ensure a quality project. We will work with you on the actual dates. We are cognizant of the fact that many projects fail because the deadlines are set too aggressively, with the result being sloppy output. Overly-aggressive deadlines often lead to scenarios where it is actually better not to have done the project at all than to produce inaccurate results. Also, when over-aggressive deadlines are not met, then we have found that it generally becomes a habit to miss deadlines. Given that, however, we will work with you on setting reasonable dates and meet all of these deadlines.

During the execution of the plan, we will make you aware of ideas that we may have to make slight modifications to the project to make it higher quality or to set up future projects to be more efficient and of higher quality. If we determine that someone on your staff should be the individual that would be doing future projects, then we will educate this individual and include them in the workflow if time permits. This may include only a review of our work on the first occurrence of the project or full involvement, depending on the situation. If we determine that your staff should be doing the work and that you have nobody who is able to do the work, then we will discuss methods of changing that for the future. You can always find consultants to perform projects for you, but for recurring projects, you are usually better off hiring a consultant and having your staff learn the tasks in order to perform them the next time. Reliance on consultants to do recurring projects is generally not in a company’s best interests.

The output of the project will be given to you in a format that you can understand. Days, weeks, or months of hard work on a project may be of little use if the output is not in a format usable by the client.

Fees are competitive and may be hourly rates or a set rate for the project.