Expert Details

Expert in Health Actuary - Insured & Self Insured

Expert ID: 735911 Georgia, USA

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I am a credentialed health actuary (FSA, MAAA) with significant experience in group and individual health insurance. I have deep experience working with both fully insured and self insured health insurance products. I am able to discuss insurance pricing, insurance reserving, and regulatory matters as well. As of January 2020, I have testified in two civil trials.

I am a shareholder in the firm Merlinos & Associates.

Expert has 23 years of experience as a health/disability actuary with broad experience within the insurance industry and as an employee benefits consultant.
His experience includes:
 Consulting to the receiver of two ACA CO-OPs to assess the work of the health plan actuaries in order to determine potential liability. Litigation is ongoing in these matters.
 Served as consulting actuary on a wrongful termination lawsuit. My testimony in the area of employee benefits assisted the plaintiff in successfully recovering more than $600,000 in a jury trial.
 Served as consulting actuary for a litigation matter concerning the coverage and projected expense of Allied Behavioral Analysis (ABA) therapy under an individual health insurance policy.
 Served as consulting actuary in a litigation matter dealing with the projected cost of providing retiree medical coverage to a group of public sector retirees.
 Served as Appointed Actuary for a health insurance company that sold group and individual insurance coverage in the ACA Marketplace.
 Consulting to employer groups with self-insured group medical insurance programs to assist them with the financial management of the plans. The scope of these engagements includes pricing, reserving, and the development of an employee contribution strategy
 Assisting state regulatory authorities with risk focused financial examinations of health (group and individual) and long-term care (LTC) insurance companies.
 Assisting state regulatory authorities with the review of insurance rate filings submitted by health (group and individual) and long term care (LTC) insurance companies.
 Developed actuarial tools to assist brokers and TPA’s in the optimal placement of medical stop loss insurance coverage.
 Provided actuarial due diligence consulting services to private equity firms related to potential acquisitions of health insurance companies and physician provider groups

Expert may consult nationally and internationally, and is also local to the following cities: Atlanta, GA

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Education

Year Degree Subject Institution
Year: 1996 Degree: MAS Subject: Actuarial Science Institution: Georgia State University
Year: 1989 Degree: BBA Subject: Accounting Institution: University of Massachusetts

Work History

Years Employer Title Department Responsibilities
Years: 2012 to Present Employer: Undisclosed Title: Principal & Consulting Actuary Department: Responsibilities: Practice Leader - Health Actuarial Consulting

Career Accomplishments

Associations / Societies
Society of Actuaries
American Academy of Actuaries
Licenses / Certifications
Fellow of the Society of Actuaries
Member of American Academy of Actuaries

Additional Experience

Expert Witness Experience
I have participated as a consulting actuary in 5 legal matters and testified in two trials.

Fields of Expertise

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