Scott A. Weltz

Scott provides financial and strategic risk management support to the insurance and healthcare industries. He assists various entities, including government programs, health plans, employers, insurance companies, and administrators. He has helped clients with product development and pricing, risk adjustment optimization, experience analysis, valuation of reserves, financial reporting, and appraisals for mergers and acquisitions.

Examples of Scott’s expertise include the following:

ACA Individual and Small Group Issuers

Scott is an expert on commercial market issues related to the Patient Protection and Affordable Care Act (ACA). His recent work includes:

• Identified ACA market strategic opportunities based on competitive intelligence consolidated from various public use files, statutory filings, and Milliman’s proprietary analytic engines.
• Helped an ACA issuer predict its competitor rate increases three years in a row.
• Helped ACA issuers identify members with the most potential for increases in risk adjustment transfer receipts.
• Worked with Milliman’s prescription drug experts to optimize ACA issuer formularies while testing for discriminatory features.
• Assisted health plans in multiple states with ACA individual and small group pricing and filing. Clients included provider-owned plans, Medicaid MCOs entering ACA individual market, traditional insurers, and start-ups.

Innovation

• Scott spearheaded the development of Milliman’s IMPROVE medical coding optimization tool for ACA issuers and Medicare Advantage organizations. It is one of the few products in this niche that "looks both ways" so plans can identify both under-coding and over-coding, as required by regulation.
• Scott helped launch Milliman’s EDGEAssist product to assist ACA issuers with EDGE server submissions with a focus on high-quality EDGE data that maximizes revenue.
• Scott is also a core member of the ideation team that identifies new product development opportunities for his practice.

Commercial Health Plans and Insurers

• Assisted several health plans with their rate renewals, including plan design changes to maintain competitive premiums while meeting minimum capital surplus requirements.
• Assisted numerous health plans with their annual statements of actuarial opinion regarding their statutory liabilities.
• Assisted health plans with large group product launches, including competitive analysis, sales projections, rating manual development, and state filing.

Employee Benefits

• Reviewed and developed a strategy for an employer to manage its employee health plan costs while still offering meaningful benefits under the challenges of the ACA.
• Worked with a business foundation on a report quantifying a region’s healthcare costs versus regional and national benchmarks.
• Assisted union and employer trustees of a Taft-Hartley multi-employer health and welfare fund with net asset projections, contribution rate setting, plan design changes, and vendor selection during collective bargaining negotiations.