Abstract: Systems and methods for segmenting claims data for actuarial modeling are disclosed. For example, traditional actuarial models determine the money paid out in a given month and estimate future months based at least in part on the money paid out, but these traditional models fail when dealing with volatile data for new markets and/or expanding member base. The presently-disclosed systems and methods segments data into incremental metrics and uses the segmented data to provide more granular information about the claims. Increasing granularity in data not only increases accuracy for predictions but the new actuarial model developed using segmented data may also be used as market analysis tools to predict favorable new markets to enter.

Abstract: A method including determining a first bid for a healthcare plan and a second bid for the healthcare plan. A bid-pricing tool is configured to utilize one or more first components to determine the first bid and one or more second components to determine the second bid, respectively. A bid difference between the first bid and the second bid includes at least a monetary difference in premiums paid by members of the first bid for the healthcare plan and members of the second bid for the healthcare plan. One or more third components are determined based at least in part on the bid difference to determine a third bid for the healthcare plan. A second bid difference is determined between at least one of the first bid and the third bid or the second bid and the third bid.

Abstract: Systems and methods for segmenting claims data for actuarial modeling are disclosed. For example, traditional actuarial models determine the money paid out in a given month and estimate future months based at least in part on the money paid out, but these traditional models fail when dealing with volatile data for new markets and/or expanding member base. The presently-disclosed systems and methods segments data into incremental metrics and uses the segmented data to provide more granular information about the claims. Increasing granularity in data not only increases accuracy for predictions but the new actuarial model developed using segmented data may also be used as market analysis tools to predict favorable new markets to enter.

Abstract: A method including determining a first bid for a healthcare plan and a second bid for the healthcare plan. A bid-pricing tool is configured to utilize one or more first components to determine the first bid and one or more second components to determine the second bid, respectively. A bid difference between the first bid and the second bid includes at least a monetary difference in premiums paid by members of the first bid for the healthcare plan and members of the second bid for the healthcare plan. One or more third components are determined based at least in part on the bid difference to determine a third bid for the healthcare plan. A second bid difference is determined between at least one of the first bid and the third bid or the second bid and the third bid.