Susquehanna Actuarial Consulting, Inc.

Team

Who We Are

Our success depends on the strength of our team. Each team member brings a depth of industry experience enabling the entire team to focus on thoughtful solutions for your company.

Kevin L. Pedlow, A.S.A., M.A.A.A., F.C.A., Consulting Actuary

Kevin has over 30 years of experience as an actuary in health insurance, managed care and reinsurance. He has experience with HMOs, PPOs, indemnity insurance, Medicare Risk products, Medicaid products and Stop Loss. Kevin has experience with strategic direction, pricing, financial reporting, setting and auditing claim and contract reserves, ACR filings and both the development and audit of MA-PD bids. Kevin is a Fellow with the Conference of Consulting Actuaries, an Associate in the Society of Actuaries, and is a Member of the American Academy of Actuaries.

Sara Hemmingson, F.S.A., F.C.A.S., M.A.A.A., Consulting Actuary

Sara has over 15 years of experience as an actuary in multiple insurance industries, including health, reinsurance and property/casualty. She has actuarial expertise in a wide variety of products, including provider risk, commercial health, Employer and Provider Stop Loss, Medicare Advantage, Medical Excess of Loss and Managed Care Reinsurance. Sara has experience with pricing, reserving, development of complex actuarial models, strategic planning and forecasting, and MA-PD bids. Sara is a Fellow of the Society of Actuaries, a Fellow of the Casualty Actuarial Society, and is a Member of the American Academy of Actuaries.

Fred Colclough, F.S.A, M.A.A.A., Consultant

Fred has over 10 years of experience as a health actuary working with both payers and providers. His experience ranges from benefit relativity modeling, commercial and stop loss valuation, and commercial pricing to most recently Medicare Advantage bid development and value-based care. Fred provided actuarial support to providers managing and negotiating risk arrangements on MA and other value-based initiatives including commercial and MSSP. Fred is a Fellow of the society of Actuaries and is a Member of the American Academy of Actuaries.

Wade A. Pedlow, Consultant

Wade has over 25 years experience in the Health Care Industry holding a variety of leadership roles across IT, Strategic Planning, Utilization Review, and Project Portfolio functions; with a particular focus on Dashboards, Reporting and Analytics. Wade was graduated from the University of Hartford with a BS in Mathematics/Computer Science, and from Bucknell University with a MSBA in Management. He also holds the Managed Healthcare Professional designation from AHIP.

Services

We Are Here For You

Our team of actuaries and consultants are able to provide a multitude of services for your organization. From our vast experience in pricing, reserving and valuation, to our hands-on Medicare Advantage bid development and associated products, to our analytics and creative reporting, we bring a refreshing clarity to your business.

Medicare
Advantage

Enabling clients to submit MA & PD Bids to CMS.

Through our integrated, iterative and consultative approach, we develop and file Medicare Advantage and Part D Bid Submissions and provide Actuarial Certification for our clients.

Base Period Development
Claim Cost, Revenue and Risk Score Forecast
Patent Expiration Impact
Formulary Change Analysis
Competitive Landscape Research
MA BPT Development
PD BPT Development
MA/PD Certification

CMS MA/PD
Bid Audits

Industry and MA/PD submission experiences elicit nuanced understanding.

Auditors should be knowledgeable. Our decades of industry experience, 10+ years of MA/PD Auditing, and facing the same challenges as other submitters provides the necessary insight and clarity to review and discuss the multitude of issues with bid submissions.

MA Only
Part D Only
MA/PD Plans
PACE Plans

Health
Plans

Listening to challenges, providing fact based solutions.

Each health plan faces their own unique challenges. Seeking first to understand yours, followed by standard or client-specific products sets the framework for finding tailored and creative solutions. Trust our collaboration to reach desired outcomes.

Pricing Strategies
Reserve Attestations
MA & PD Utilization Reporting
Medicaid Utilization Reporting
Competitive Market Position

Employer
Groups

EGWPs require specialized understanding.

From very specific Part D pricing rules to varied MA pricing strategies, EGWPs can be complicated to price and administer. We provide specific understanding of this unique market to our clients.