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Process Group

Financial Operations Management

Objective

Optimize premiums to reflect realistic economic conditions while minimizing medical loss ratio.

Input

  • Fee schedule

  • Actuarial projections (i.e. health spending projections

  • Claims history

  • Benefit plan

Output

  • Premium rate schedule (premiums for each benefit plan

  • Update premium collection amount

Measurable Outcomes

  • Premium rates schedule for each benefits class

  • Sum of premiums sufficient to meet the cost for medical claims and reserve funds for the year

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