有正在浏览此页的北美精算师滴学子咩？高顿网校小编赠送您如下的SOA精算师考试历年真题——November2004Course8M（二）
　　8.(5points)LMNCompanyemployeescurrentlyutilizetwodifferentnetworks.Both
　　networksusethesamepharmacybenefitsmanager,anddetailedpharmacyclaimsdata
　　areavailable.NetworkAhasadditionaldetailedhealthclaimsinformation.Theper
　　capitaclaimscostforNetworkAistwiceashighasinNetworkB.Youhavebeenasked
　　todetermineifthehighercostsarecausedbydifferencesintheenrolleehealthstatus.
　　(a)Describecriteriausedforhealthriskclassification.
　　(b)Describeriskassessmentmodelscurrentlyavailable.
　　(c)RecommendariskassessmentmethodforLMNCompany.
 
　　9.(7points)Youareanactuarywhorecentlyacceptedanon-traditionalroleasclaims
　　managerforahealthcarrier.Youareconcernedaboutthenewinventorystandards,as
　　measuredbyturn-aroundtime(TAT)andtheirimpactonquality.Additionally,youare
　　concernedaboutcommonclaimsproblemsandthelackofdocumentedproceduresand
　　guidelineforworkingwithotherdepartments.
　　(a)RegardingTAT:
　　i.DefineTAT.
　　ii.DescribeconsiderationsusedwhenestablishingTATgoals.
　　iii.DescribethetoolsusedfortrackingandmonitoringTATs.
　　(b)Regardingquality:
　　i.Definethemeasuresofclaimquality.
　　ii.Listthestepsofclaimqualityreviewprocess.
　　iii.Describethemajorissuestoconsiderwhenperformingaqualityaudit.
　　(c)Describecommonclaimsandbenefitadministrationproblems.
　　(d)Listtheitemsrequiringproceduresandguidelinesforcoordinationoftheclaim
　　departmentwiththefollowingdepartments:
　　i.Enrollmentandbilling
　　ii.Providerrelations
　　iii.Utilizationmanagement
　　iv.Memberservices
　　v.Finance
　　COURSE8:Fall2004-7-STOP
　　Health,GroupLife&ManagedCare
　　MorningSession
 
　　10.(4points)AsaresultofthenewMedicarePrescriptionDrugImprovementand
　　ModernizationActof2003itmaybenecessaryforaplansponsortoperformanactuarial
　　valuationtodetermineactuarialequivalencebetweenthesponsor’splanwiththebasic
　　Medicarebenefit.
　　Assumethatcostsoverage65forthesponsor’splanare$1,500peryearandplancosts,
　　ontheaverage,increaseby3%peryearabove65.Assumethatthedemographicsareas
　　follows:
　　Demographics
　　AgeGroupNumber
　　65to69200
　　70to74400
　　75to79300
　　80to84100
　　Total1,000
　　(a)Outlinetheassumptionsneededtoperformanactuarialvaluationofthesponsor’s
　　plans.
　　(b)Developthesponsor’splancostsbyagegroup.
　　(c)Describethefinancialimpacttotheplansponsorofthethreepossibleoutcomes
　　whendeterminingactuarialequivalence.
　　**ENDOFEXAMINATION**
　　MORNINGSESSION
　　COURSE8:Fall2004-8-GOTONEXTPAGE
　　ManagedCareSegment
　　AfternoonSession
　　**BEGINNINGOFEXAMINATION**
　　MANAGEDCARESEGMENT
　　AFTERNOONSESSION
　　BeginningWithQuestion11
 
　　11.(4points)
　　(a)Describethetypesofclaimliabilitiesandreserves.Foreach,provideanexample
　　ofaneventwhichwouldrequiresuchaliabilityorreservestobeestablished.
　　(b)Describecommonmethodsusedtoestimateclaimreserves.
　　12.(6points)CompanyXYZmanagementhasdecideditistimetoinvestresourcesinto
　　developingbetterreportingandanalyticalsystems.
　　(a)(2points)Describewaysdatacompiledintheclaimadjudicationprocesscanbe
　　usedforreportingandanalysis.
　　(b)(3points)Compareandcontrasttypesofdatastructuresandphysicalmediaused
　　tostoredataincomputersystems.
　　(c)(1point)Describeconsiderationswhenchoosingadatastructureandstorage
　　media.
　　COURSE8:Fall2004-9-GOTONEXTPAGE
　　ManagedCareSegment
　　AfternoonSession
　　高顿网校之极品语录：一个青年要是相信他日后必定成个不朽的文学家，他心里自然会感到无比的快慰：这可以说是人生再甜蜜不过的时刻。这种抱负的确是很高贵，然而可惜的是，根基往往是太不牢靠了。 —— 马克·吐温