One of the first models I adopted and developed was the Outstanding Claims Model, which uses an Actuarial “Chain Ladder” method to estimate the amount of services/procedures that members have undergone though haven’t yet sent through a claim for. This is commonly known as claims that have been incurred but not yet reported (IBNR). We estimated this future liability and held a provisional amount of money for it, including an additional proportion on top of this as a “risk margin” to account for the margin of error in our estimate (being a central i.e. middle of the range estimate).

To assist with Pricing submissions to the Department of Health, I built an excel-based model to capture and compare the results of different scenarios resulting from changing certain inputs/variables. It was designed with maximum flexibility in mind that allows the output to be summarised in many different ways and to keep a log of the inputs.

I’ve used R to build many tools to extract recent historic data, exclude once-off impacts that we don’t expect to continue, and use it to extrapolate trends to predict what might happen in future. This assists with informing management of year-on-year trends of things such as growth of members, their associated premium revenue, claim volumes and profit margins.