Cliff Frank
Healthcare Management Solutions, Inc.
caphelp@msn.com cliffsconfab@gmail.com (904) 874-6134
Kent has over 28 years of healthcare actuarial experience, with over 23 years at industry-leading consulting firms. He has worked with HMOs, insurance companies, provider groups, employer groups, governments, and device manufacturers; helping clients with pricing, reserving, provider contracting, financial modeling and compliance services.
As a credentialed actuary, Kent is qualified to perform actuarial certification services involving premium rate and annual statement filings with State governments and CMS. This includes development and preparation of Actuarial Memoranda and corresponding Actuarial Certification of large group, small group, and individual premium rate filings; Medicare Advantage bid submission and certification; and Prescribed Statements of Actuarial Opinion and supporting Actuarial Memoranda for statutory financial statement filings.
In addition to traditional actuarial services, Kent has a long history of proactive problem solving using a combination of detailed technical skills and outside-the-box thinking. Such projects often involve complex interactions of multiple factors, including but not limited to risk tolerance, regulations, and available data. Constant and effective communication with clients and stakeholders is a necessity.
Some examples of specific projects include:
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Development of monthly IBNP estimates and quarterly PDR estimates;
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Prepare and submit Medicare Advantage BPTs and PBP Tool entries;
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Annual rate filings for ACA, large group, small group transitional, MEWA, and Medicare Supplement products;
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Pricing of EGWP rates for specific groups;
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Implementation of health status risk adjustment into commercial underwriting process;
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Creation of automated MLR reports for various lines of business;
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Assistance with provider contracting negotiations, including hospitals, physicians, and ancillary capitated vendors;
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Development of Medicaid rates for competitive bid submission;
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Actuarial valuation of individual health block of business for an insurance company;
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Actuarial valuation of a provider-owned health plan;
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Detailed trend analysis for a Blue Cross Blue Shield organization;
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Financial projections for a potential health plan start-up;
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Development of pricing model for a value-based health benefit plan;
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Competitive pricing analysis of C-PAP devices for a manufacturer;
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Efficacy research, including analysis of IP hospital utilization reductions for a DME manufacturer;
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Actuarial certification of multiple ACA and other rate filings; and
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Analysis of certificate of need premium impact model
Kenton J. Roepke, ASA, MAAA
Professional History
Vice President of Actuarial Services, Healthcare Management Solutions, Inc.
Director of Actuarial Services, The Healthplan of West Virginia
Consulting Actuary, Milliman, Inc.
Manager, Reden & Anders
Manager, Deloitte
Education
BS in Mathematics, University of Minnesota
Professional Associations
Associate of the Society of Actuaries
Member of the American Academy of Actuaries