Health Section: Estimating Large Claims – Predictive Modeling vs Traditional Methods

Roger Loomis sits down with Stephanie Moench and Michael Rustemeyer to discuss their paper that was just published by the SOA Research Institute: “Long-Term Care Wellness Primer”, which can be downloaded here: https://www.soa.org/resources/research-reports/2025/long-term-care-wellness/

Listen to Juan Herrara and Danny Moore discuss pending claims, large claims, and using predictive analytics and other modeling techniques to develop these estimates.

Anders Larson and Shea Parkes discuss using GenAI applications with coding agents to simulate healthcare costs.  They revisit the distinction between large language models (LLMs) and the applications that wrap them.  They then use some newer GenAI application functionality to generate some simulated healthcare cost distributions.  During their discussion they explore what domain knowledge the modern LLMs already have, and how to supplement that with their own domain expertise.

Description: Listen as co-hosts Jackie Lee and Josh Hammerquist speak to data scientist Supriya Ramachandra as they discuss how she attacks messy data with Artificial Intelligence and Machine Learning. From this discussion, actuaries will learn about how these cutting-edge tools can be used in their work. PleaseNote:  At timestamp 11:00: The training data was created through manual annotation — it took 4 annotators about a week to label the clinical notes. At timestamp 12:24–12:26, we said “non-supervised” — the correct term is “unsupervised learning."

In this month’s YPAC podcast host Shawn Stender, FSA, MAAA will be joined by Simon Gervais, FSA, MAAA to discuss an often-overlooked topic for young actuaries. With so much focus given to career advancement and “managing up,” actuaries looking might overlook the benefits of managing down to promote younger professionals within their organization. This podcast will discuss how managing down can not only benefit your career, but also the actuarial profession. 

Join Danny Moore and Aaron Jurgaitis as they discuss tertiary and quaternary care from an actuarial perspective. Danny and Aaron discuss: Definitions around the different levels of care, from primary up to quaternary Specifics around the types of care delivered in the specialized facilities that deliver this care, and The key themes actuaries need to keep in mind when analyzing data that include these types of services. Aaron shares information from his background of performing analysis for pediatric and academic facilities that highlight important factors that actuaries should consider, such as relative efficiency, referral patterns, episodes of care vs. points in time, and the specific value of expertise that these facilities contain. The information shared is relevant from both a provider and payer point of view, and will broaden your understanding of the unique characteristics of tertiary and quaternary care providers.

In this episode Joe Alaimo interviews Jeremy Levitt.  Actuarial models are central to decision-making across insurance, finance, and risk management—but without proper validation, even the most sophisticated models can lead to costly errors. In this episode, Joe and Jeremy take a deep dive into model validation: defining its purpose, outlining key procedures, and highlighting the risks of getting it wrong. Jeremy shares expert insight on balancing thorough analysis with real-world constraints like timelines and budget, while also addressing cultural and structural barriers to effective validation. We also explore how AI is beginning to influence model validation, from automated testing to AI-driven challenger models. Whether you're a practicing actuary, a risk professional, or a stakeholder relying on actuarial outputs, this conversation offers valuable guidance on how to build confidence in your models—and the decisions they support.

Join host Justin Le, ASA, MAAA for a talk with Kate Smith FSA, MAAA about finding meaning and purpose in our work as actuaries. Kate is a Director and Actuary working in Valuation at Penn Mutual Life Insurance Company. In this episode Kate shares her perspective and advice on connecting her work to the impact on her company’s members.

Listen as Danny Moore interviews Charlie Larimer on Epidemiology and Predictive Analytics.  Listen as Charlie gives his insight on applying predictive analytics techniques to determine drivers of health outcomes in differing populations and regions.

This interview featured Amanda Hug, the president and chair of the Society of Actuaries, discussing the role of actuaries in building trust with AI models. Amanda shared a personal anecdote from a trip to Uganda, highlighting the global reputation of actuaries. The discussion covered the importance of integrity, excellence, and professionalism in the actuarial field and provided advice on incorporating AI into actuarial processes while maintaining ethical standards.  Contributors: Amanda Hug, FSA, MAAA ;  Jon Forster, ASA, MAAA Thanks for watching and don’t forget to subscribe!