如下是SOA真题放送November2003Course8M（五）——2014年北美精算师，好好看大纲，然后开心的去玩耍吧。
　　You are also given the following additional information:
　　?  7 years of claims history for one individual
　　Year Claims
　　1 -
　　2 500
　　3 -
　　4 -
　　5 1,000
　　6 1,000
　　7 -
　　?  Expected Value of the Process Variance = 133,581
　　?  Target Loss Ratio = 80%
　　?  Ignore the impact of trend
　　(a) Calculate the expected gross premium for this product. Show your work.
　　(b) Calculate the credibility. Show your work.
　　(c) Calculate the credibility weighted total premium for this individual. Show
　　your work.
　　COURSE 8: Fall 2003 - 9 - GO ON TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
 
　　12. (4 points) ABC Company is considering acquiring ITSA, a managed care organization
　　that services a number of major cities. You are the head of the claims department in the
　　Major Medical division and you’ve been asked to *uate claims operations at ITSA,
　　including systems used to process the claims.
　　(a) Describe measures of claims quality.
　　(b) Outline basic steps you would expect to find in the ITSA claims adjudication
　　process.
　　(c) Describe specific internal data sources you should include as part of your claims
　　review.
　　(d) Describe issues that should be considered in performing an audit.
 
　　13. (4 points) You have been asked by your client at BEST HMO to create a presentation that
　　will enable her to convince management to establish new methods for physician
　　compensation.
　　(a) Describe traditiona l and new, alternative forms of capitation and their suitability
　　for specific types of physicians.
　　(b) Describe traditional and new, alternative forms of incentive plans.
　　COURSE 8: Fall 2003 - 10 - GO ON TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
　　高顿网校之短句汇编：要用你的梦想[*{c}*]你的一生，要用感恩、真诚、助人圆梦的心态[*{c}*]你的一生，要用执著、无惧、乐观的态度来[*{c}*]你的人生。——李开复