Jose Carlo

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