Jose Carlo
Associate Actuary
San Francisco, CA, US
Jose Carlo is an associate actuary in the San Francisco office of Milliman. He joined the firm in 2009.
Experience
Jose has worked on various actuarial projects focused on healthcare data analysis, value-based benefit design and pricing, healthcare cost benchmarking, and state rate filings for health insurers. He has worked extensively with state Medicaid agencies providing actuarial support on projects such as:
- Setting capitation rates and negotiating contracts with Managed Care Organizations (MCOs)
- Analyzing and developing provider fee schedules
- Supporting annual State budget requests at the local and federal levels in Congress
- Estimating the financial impact of policy and program changes
- Developing cost-saving strategies through plan design, managed care model changes, and MCO compliance
He has also developed expertise in performing medical claims audits with the Milliman Technology and Operations Solutions (TOPS) practice. His roles for audits include:
- Evaluating plan adherence to contractual requirements and conditions with clients
- Assessing overall plan administration and claim adjudication in accordance with plan design
- Verifying and assessing claim processing procedures through manual review of medical claims during on-site audits
Professional Designations
- Associate, Society of Actuaries
- Member, American Academy of Actuaries
Education
- BS, Financial and Actuarial Mathematics, University of Michigan, Ann Arbor
Publications
Read their latest work
Article
Critical Point Episode 8: Puerto Rico after the hurricane: Managing Medicaid in the face of a natural disaster
14 January 2019 - by Jose Carlo
Managing Medicaid in Puerto Rico after Hurricane Maria was part of Jose Carlo’s job, but it was also personal for the Milliman consultant.
Article
“A” is for actuary
28 September 2015 - by Jose Carlo, Jason Cai, Darin Muse
Actuarial science is now recognized by digital health companies as an integral part of their development.