Career decision - Regarding Actuarial and Insurance (Group Health)

I currently work near actuaries at a small insurance advocacy company (we operate both as a customer service operation and a broker/consulting operation) I help run the broker/consulting side of the business so I’m constantly in contact with the major insurance carriers (Group Health Benefits). My current role is to analyze plan designs from potential clients. Look at their claims, develop a cost, and then work with Insurance companies to obtain the best possible price. Then I make marketing materials, approve costs, and send to the sales team. I’m a hodgepodge of proposals and underwriting; but I am in charge of the unit that does this.

What I was wondering is that I recently went back to school to firm up my math skills. I wanted to learn how to become an actuary. While in my current role I’m considered to be part of senior leadership in the company; I believe what I wanted to do is have something akin to having a trade in this industry. You know something I could reliable fall back into or move over to if something were to happen down the road.

Is being an actuary the right type of skill I’m thinking of? What I really want to be able to do is get a book of claims and analyze them to develop a PMPM cost for a group. I want to be able to look at their assets, look at their claim cost, and develop a pricing model so I can help them get the best possible price for their group.

I’m not sure if actuarial work is what I should be looking into. What I do know so far is when I deal with UW at these companies in often talking directly to the Actuarial teams and the consultants our sales team often works with are actuarial consulting companies. So I figured that it would be a good set of skills to develop and have a formal training in.

Last question here—is there a part time actuarial undergrad program you can enroll into while you work? I’m aware you have to take the exams and it doesn’t really matter what your prior history is so long as you can pass them, but I figured the best way for me to do that is obtain another formal education and move myself forward.

Am I on the right track here or am I missing this entirely?

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Welcome. You’re on the right track. A couple of comments:

  1. I wouldn’t go back to school for this, not if you’re working. Study for the exams directly, pass them. Nothing else matters very much. You’re basically duplicating effort by going to school and then studying for exams. Just study for exams.
  2. Push at your employer to pay for exams, study material, and ideally paid time off to study. This ‘exam support’ is common in actuarial employers.

Be aware that exams take a LOT of time to study for and pass. More effort than a college/university course final exam.

To add to SL, if you were to switch to Actuarial I imagine they would discount your non-actuarial years of experience pretty heavily so it would probably be a significant step down, even if experienced actuarial pay would be enticing.

Actuarial is definitely the route to learn how to price, but I might be tempted to just pursue the skills more than actually become an actuary if I were quite senior in an adjacent role.

I appreciate the feedback.

I think for the time being I’ll stick to doing a few more classes. (I’m attending a community college, so costs aren’t outrageous) just to continue to firm up my math skills. Once I get through I think Calc 3, Stat 2, and maybe an accounting course–I’ll start studying for the exams.

Good news here is I won’t go into 20-40K worth of debt studying for this stuff with a formal education. But I do want a refresher on the more advanced math. Currently in my role I know how the insurance operates with regards to who pays, what, and how long a fund can last with regards to solvency on a question of Self-Insuring vs Fully Insured products. But why I want to be an actuary is so I can look at a fund and have them provide me these documents then come up with a predicitve model on how much they’ll spend based off of their population, gender, zip, and industry. I don’t think I can do that with the current skillsets I have.

Right now I’m just basically organizing claims into excel documents and pivot tables to show how much a fund is spending, who their highest costing members are, and I estimate how much a potential benefit change could cost based off of market intel.

I’ll just drop this here to make sure you’re aware of it:

Because, I can see some shitty people deciding to fire someone for some other cause (or none at all) because their child (part of the policy) has cancer. Just to save some premium for the company.
It is called “PHI,” and you could get in serious trouble with the Feds.

Otherwise, my standard answer applies: Pass some exams and get back to us. Seriously.
Try some practice exams for the first course (they call them “courses”). See how well you do, what you need to improve on. I don’t think Calc 3 is all that necessary, though there might be some double- or triple-integration required. If so, you skip that question, on to the next. I believe this site also has separate forums for each of the SOA and CAS exams (someone’s bright idea 20 years ago), so you can ask specific questions about an exam as they come up in those, and other posters also taking those exams can answer.

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I think I should note here: When working with claims there’s a specific field called a “Scrambled Member ID” Which eliminates the PHI of the member and gives a unique code that has nothing to tie back to them. It’s used to see if a plan has a high specialty drug usage which is used to create Pharmacy pricing.

Anything PHI is always removed where the only remainder is essentially Here’s:

Scrambled ID Code:2x4TGz!3LZ456:
Claim Filed: $xxx.xx.
Claim Paid: mm/dd/yyyy
Prescriber #:XXXXX
Mail/Retail Indicator: X
Tier: X

Also please note–I am HIPAA certified, and am AHIP certified as well. PHI is something I take very serious. I’m quite aware. Lastly a Insurer who currently insures a group where a member has Cancer or some kind of other illness cannot drop people as a result of said illness; furthermore while the employer is as far as I’m aware can access that PHI with regards to claims because they are the policy holder they cannot fire someone as a result of said claim on the health insurance policy. If the DoL or any other type of legal authority were investigating a retaliation case we would be obligated to comply.

The only reason we use scrambled member IDs when looking at claims is not to indicate who is spending what; but rather to determine if there’s a trend in the group, and mainly to determine the actual number of utilizers on a claims file vs that of a census file. I.E: 400 people enrolled in a policy, but only 380 people currently utilizing the benefit. It’s used so we can verify the integrity of the data. Nothing more nothing less. There is never any PHI transmitted to those who do not have access to said PHI.

Good to know, and welcome to our humble community!

Thanks–Glad to read here.

Was at Reddit for a bit but it seems like a lot of the posters there aren’t in the Health Industry but rather P&C so its hard to guage good answers there.

My background as of today is I need a lot of mathematical work that’s why I’m starting out at Pre-Calc and working my way up because a lot of the forumlas I need refreshers on and work on. I know I’m a few years away from even attempting to take the exams.

You can take the exams whenever and however many times you want. Paying for them over and over can be an issue. So, take some practice exams for Course P, get a supplemental study manual (they key in on the designs of the questions, and how to interpret the process of the solution), and improve every day.
Here is a three-year-old article about Course P and study manuals. Our Course P forum might be more up-to-date, and with more opinions.

Important snippet:

The syllabus mentions some recommended textbooks to read, but the problem is that they’re not specifically designed to help you pass Exam P. They’re just regular text books like you might have been assigned to read in your college or university courses.

Fortunately, many actuarial-minded people have set out to help you prepare for your exam as efficiently as possible. So, they’ve condensed all those recommended textbook readings into a more manageable package that relates everything specifically to Exam P.

These study materials will not only teach you the concepts that you need to know, but they’ll also give you specific examples about how the topics could be tested on the exam. Better yet, they come with tons of sample Exam P practice problems that you can use to prepare. That’s something you won’t get by just reading through the recommended textbooks.

You seem to be doing actuarial work, based on your OP. Time to get paid as one.

:tup: & :ctm:

Start with this syllabus and book: Group and Health Core Exam | SOA. The math is not complicated.

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