Consultant - Actuarial Analysis of the Osun State Health Insurance Scheme at Palladium Group

Project Overview and Role

• The Osun state Government has signed into law, a bill that establishes the Osun State Health Insurance Scheme (OHIS) with the overall goal of ensuring all residents of the state have access to quality and affordable health care services with financial and social risk protection. As part of the design of the scheme, a health benefits package has been developed to ascertain the health services to be provided as entitlement to enrollees on the scheme.
• The overall aim of this consultancy is to support the pricing of the Osun benefit package and determine an actuarially fair priced premium including the appropriate distribution of medical claim costs, admin costs and reserve margin and the appropriate payments for capitation and fee for service for providers in order to inform the selection of a financially sustainable premium and processes for OHIS.

Responsibilities
Deliverables:

• A comprehensive actuarial study report for the Osun benefit package scenarios containing:
• Appropriate premium (Individual and Family package) to cover medical costs, overhead administrative costs, and reserve margin of the scheme.
• Determination of an appropriate premium rate for individual/household package and additional family members.
• Modular pricing for the Osun benefit package including the different scenarios and disease conditions for individual and household packages.
• Rates for medical payouts (Capitation fee and Fee-for-Service), including tariff structure for procedures, consultations, pharmaceuticals and diagnostics.
• Rates for administration fee to HIAs/TPAs/OHIS.
• Expected Period of performance of the consultant: 10th December to January 15th 2018.

Requirements
Skills and Expertise Required:

The consultant should be a licensed actuary and possess the following:

• An advanced Degree in Mathematics, Statistics, Finance, Insurance and Actuarial Science or other quantitative fields with about 7 years' experience in this field.
• Strong statistical, analytical and monitoring skills with solid understanding of all life/disability actuarial techniques, standards, and assumptions
• Strong knowledge of insurance operations and the procedures of Financial, Underwriting, Claims, Statistical, Information Technology, Legal, and Sales departments
• Experience in conducting actuarial analysis for health insurance in Nigeria.
• Must have led rate-making and pricing initiatives for insurance products.
• Effective written and verbal communication skills in presenting recommendations to non-actuaries.
• Advanced computing knowledge and high proficiency in use of Spreadsheet applications.
• Membership of Chartered Insurance Institute of Nigeria will be an added advantage.