U.S. Medical, Dental, Vision, Pharmacy Specialist

2 sequenced courses

GH 101
Benefits and Pricing ▼
  • Plan & Product Provisions: The candidate will understand how to describe plan provisions typically offered under short-duration contracts (medical, dental, vision, prescription drug, group life).
  • Manual Rates: The candidate will understand how to calculate and recommend a manual rate for each of the contracts described in Learning Objective 1.
  • Underwriting & Funding: The candidate will understand how to apply principles of pricing, risk assessment, and funding to an underwriting situation.
  • Employee Benefits: The candidate will understand how to evaluate and recommend an employee benefit strategy.
GH 201-U
Valuation and Regulation, U.S. ▼
  • Assumes knowledge from GH 101
  • Reserving: The candidate will understand how to apply valuation principles for short duration group and health insurance contracts.
  • Financial Statements: The candidate will understand how to prepare and interpret insurance company financial statements in accordance with Statutory Accounting Standards and GAAP.
  • Regulation: The candidate will understand how to evaluate the impact of regulation on insurance companies and plan sponsors in the US.
  • Flow of Funds: The candidate will understand how to describe the flow of funds in the health care system and the role of providers in the system.
  • Government Programs: The candidate will understand how to describe government programs providing health benefits in the US.

2 additional courses

GH 301
Health Analytics and Management ▼
  • Provider Contracting: The candidate will understand how to evaluate the effectiveness of provider reimbursement methods from both a cost and quality viewpoint.
  • Disease Management: The candidate will understand how to evaluate health care intervention programs.
  • Risk Adjustment: The candidate will understand how to apply risk adjustment in actuarial work.
  • Social Determinants of Health: The candidate will understand how to explain the determinants of health and their impact on health care costs and policy.
  • Medical Data: The candidate will understand how to describe medical coding, sources of data, and data quality.
  • Predictive Analytics: The candidate will understand how to apply the framework of predictive analytics to health care data and business applications.
CFE 101
Enterprise Risk Management ▼
  • The candidate will understand the fundamentals of ERM and be able to apply them considering both the internal and external environments.
  • The candidate will understand the types of risks faced by an entity and be able to identify and analyze these risks.
  • The candidate will understand how to embed ERM into decision-making for an organization.
or
CP 321
Disability, Long-Term Care, and Long-Duration Health Contracts ▼
  • Plan & Product Provisions: The candidate will understand how to describe benefits typically offered under long-duration contracts (disability income, long-term care, critical illness, Medicare Supplement).
  • Manual Rating: The candidate will understand how to calculate rates for each of the contracts described in Learning Objective 1.
  • Reserving: The candidate will understand how to apply valuation principles for long-duration contracts.
  • Financial Statements: The candidate will understand how to prepare and interpret insurance company financial statements for long duration contracts.
  • Retiree Group Benefits: The candidate will understand how to design and perform valuations of Retiree Group Benefits.
  • Asset Adequacy: The candidate will understand how to apply asset matching and asset adequacy standards as they apply to long duration contracts.