Jill’s primary area of expertise is government managed care programs. She has over 25 years of health actuarial experience, including over 15 years working with Medicaid, Medicare Advantage, and Part D.
Jill develops capitation rates for state Medicaid agencies and advises Medicaid Managed Care Organizations (MCOs). Examples include:
- Working with the WI Medicaid program for over 15 years with both the state and an MCO
- Designing a comprehensive financial template to use for capitation rate development, encounter data validation, and medical loss ratio (MLR) reporting
- Evaluating the financial implications of using high-cost prescription drugs to treat members infected with hepatitis C
- Working with the Milliman teams developing FL and MN Medicaid capitation rates
- Providing a MI MCO with guidance on capitation rates and financial projections
- Evaluating entry into new eligibility categories and service areas
Examples of Jill’s Medicare Advantage and Part D expertise include:
- Certifying bids since 2006
- Leading bid audits and participating in financial audits
- Developing in-house pricing models and reporting from CMS files while employed by an MCO
- Contributing to product design, service area expansion, strategy, and policy
- Preparing budgets, re-forecasts, reserves, and accruals for financial reporting
- Developing provider capitation rates and risk-sharing arrangements
In a prior role, Jill led the rate development and rate filings in 17 states for individual major medical and Medicare Supplement policies, including pricing new products and states. She also has expertise with commercial group pricing and providers.
