Scott Jones
FSA, MAAA
Principal and Consulting Actuary
Seattle, WA, US
Scott Jones is a principal and consulting actuary with Milliman’s Seattle Health Practice. He has 20 years of actuarial experience.
Experience
Scott's actuarial experience includes pricing, rating, reserving, regulatory filings, and expert testimony, and he has worked with Veterans Healthcare, Medicare, and Commercial populations.
Recent projects include:
- Participating on a team developing the Department of Veterans Affairs Enrollee Health Care Projection Model. Leading enrollment projections, including special populations and eligibility (e.g., VA Choice & MISSION, combat Veterans, community vs. VA facility patient distributions, etc.)
- Analyzing the impact of legislation and administrative policies on the VA’s integrated health care system
- Estimating Incurred But Not Reported (IBNR) claim liabilities
- Certifying actuarial assets and liabilities on insurance company financial statements
- Developing revenue recognition models for ASC 606, including conducting analysis of policy persistency
- Developing commercial exchange filings and consulting; testing mental health parity
- Conducting Medicare Advantage bid development
- Preparing commercial and Medicare Advantage medical loss ratio (MLR) filings
- Leading the firm’s weekly internal call on ACA-related pricing, filing, and regulatory matters for two years
Publications and Presentations
- ACA RADV for 2020 Year-End Financial Reporting (Society of Actuaries Health Financial Reporting Subgroup, December 2020).
- Comparing health insurance company surplus levels (Milliman Insight, August 2020).
- Health insurer balance sheets 10 years after ACA (Health Watch, June 2020).
- Impact of Quality Improvement Activities on Medical Loss Ratio (Society of Actuaries Annual Health Meeting, 2019).
- Risk-based Capital (RBC) (Milliman Health Forum, October 2018).
- I’m the Appointed Actuary for the Orange Blank – Now What? (Valuation Actuary Symposium, August 2018).
- Case Studies in Commercial Risk Adjustment Valuation (Society of Actuaries Annual Health Meeting, June 2018).
- Reserving for Commercial Risk Adjustment Payment Transfers (Society of Actuaries webinar, December 2017).
- Impacts of hurricanes on health outcomes and health insurance company operations (Milliman Insight, October 2017).
- Medicare Advantage MLR: year two (Society of Actuaries Annual Meeting, October 2016).
- Medical loss ratio and actuarial value: application to dental products (NADP CONVERGE, September 2016).
- Related party considerations for Medicare bids (Society of Actuaries Annual Health Meeting, June 2016).
- Medical Loss Ratio (MLR) in the “Mega Reg”: Medicaid adopts comprehensive MLR standards (Milliman Insight, June 2016).
Professional Designations
- Fellow, Society of Actuaries
- Member, American Academy of Actuaries
Education
- MA, Mathematics, Statistics, University of Montana
Publications
Read their latest work
Article
The retrospective trend adjustment: Looking back, looking forward
15 April 2024 - by Scott Jones, Chris Smith, Tabish Shaikh
REACH ACOs need to incorporate into financial projections another likely retrospective trend adjustment from the Center for Medicare and Medicaid Innovation.
Article
Oregon’s Health Care Cost Growth Target program: Implications of health plan penalties
11 October 2023 - by Scott Jones
We cover key considerations regarding Oregon’s Health Care Cost Growth Target program, including the potential financial and non-financial impacts for health plans.
Article
Proposed health savings account plan options in individual marketplace
26 October 2022 - by Mike Hamachek, Scott Jones
Roughly two of three individuals would benefit by choosing an HSA plan over a comparable non-HSA plan.
Article
Comparing health insurance company surplus levels
27 August 2020 - by Scott Jones
This white paper discusses the basic elements of surplus, including its purpose, uses, and funding.
Article
Impacts of hurricanes on health outcomes and health insurance company operations
23 October 2017 - by Lynn F. Dong, Scott Jones, Michael J. Polakowski
From an operational and financial perspective, natural disasters can have significant effects on healthcare providers, insurers, and payers.
Article
Medical loss ratio (MLR) in the “Mega Reg”
27 June 2016 - by Jill Brostowitz, Scott Jones, Ian M. McCulla
While the Medicaid medical loss ratios (MLR) formula itself largely follows the commercial and Medicare Advantage (MA) MLR formula, there are key differences between the Medicaid minimum MLR standards and those currently established for the commercial and MA markets.