Scott Jones

FSA, MAAA

Principal and Consulting Actuary

Seattle, WA, US

Scott Jones is a principal and consulting actuary with Milliman’s Seattle Health Practice. He has 20 years of actuarial experience.

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Experience

Scott's actuarial experience includes pricing, rating, reserving, regulatory filings, and expert testimony, and he has worked with Veterans Healthcare, Medicare, and Commercial populations.

Recent projects include:

Participating on a team developing the Department of Veterans Affairs Enrollee Health Care Projection Model. Leading enrollment projections, including special populations and eligibility (e.g., VA Choice & MISSION, combat Veterans, community vs. VA facility patient distributions, etc.)
Analyzing the impact of legislation and administrative policies on the VA’s integrated health care system
Estimating Incurred But Not Reported (IBNR) claim liabilities
Certifying actuarial assets and liabilities on insurance company financial statements
Developing revenue recognition models for ASC 606, including conducting analysis of policy persistency
Developing commercial exchange filings and consulting; testing mental health parity
Conducting Medicare Advantage bid development
Preparing commercial and Medicare Advantage medical loss ratio (MLR) filings
Leading the firm’s weekly internal call on ACA-related pricing, filing, and regulatory matters for two years

Publications and Presentations

ACA RADV for 2020 Year-End Financial Reporting (Society of Actuaries Health Financial Reporting Subgroup, December 2020).
Comparing health insurance company surplus levels (Milliman Insight, August 2020).
Health insurer balance sheets 10 years after ACA (Health Watch, June 2020).
Impact of Quality Improvement Activities on Medical Loss Ratio (Society of Actuaries Annual Health Meeting, 2019).
Risk-based Capital (RBC) (Milliman Health Forum, October 2018).
I’m the Appointed Actuary for the Orange Blank – Now What? (Valuation Actuary Symposium, August 2018).
Case Studies in Commercial Risk Adjustment Valuation (Society of Actuaries Annual Health Meeting, June 2018).
Reserving for Commercial Risk Adjustment Payment Transfers (Society of Actuaries webinar, December 2017).
Impacts of hurricanes on health outcomes and health insurance company operations (Milliman Insight, October 2017).
Medicare Advantage MLR: year two (Society of Actuaries Annual Meeting, October 2016).
Medical loss ratio and actuarial value: application to dental products (NADP CONVERGE, September 2016).
Related party considerations for Medicare bids (Society of Actuaries Annual Health Meeting, June 2016).
Medical Loss Ratio (MLR) in the “Mega Reg”: Medicaid adopts comprehensive MLR standards (Milliman Insight, June 2016).

Professional Designations

Fellow, Society of Actuaries
Member, American Academy of Actuaries

Education

MA, Mathematics, Statistics, University of Montana

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Publications

Read their latest work

Article

米国の営利健康保険会社と非営利健康保険会社の比較：資本および剰余金の管理方法

10 December 2025 - by Scott Jones, Bill Miller

営利健康保険会社と非営利健康保険会社では、どのように資本および剰余金を管理しているのでしょうか。ミリマンでは、RBC比率、純利益、資本の増加などの指標を比較しました。

Article

Comparing for-profit and not-for-profit health insurers: How capital and surplus are managed

10 December 2025 - by Scott Jones, Bill Miller

How do for-profit and not-for-profit health insurers manage capital and surplus? We compare metrics such as the RBC ratio, net income, and growth of capital.

Article

Refining Medicare FFS expenditure projections in ACO REACH: Seasonality and completion

19 February 2025 - by Tyler Edwards, Scott Jones, Chris Smith

We review important considerations for accountable care organizations participating in Medicare’s ACO REACH model.

Article

PY2025 ACO REACH RTA tailwind

07 January 2025 - by Caroline Li, Scott Jones, Chris Smith

Performance-year 2025 for ACO REACH: The final retrospective trend adjustment is likely to be favorable for the benchmark.

Article

The retrospective trend adjustment: Looking back, looking forward

15 April 2024 - by Scott Jones, Chris Smith, Tabish Shaikh

REACH ACOs need to incorporate into financial projections another likely retrospective trend adjustment from the Center for Medicare and Medicaid Innovation.

Article

Oregon’s Health Care Cost Growth Target program: Implications of health plan penalties

11 October 2023 - by Scott Jones

We cover key considerations regarding Oregon’s Health Care Cost Growth Target program, including the potential financial and non-financial impacts for health plans.

Article

Proposed health savings account plan options in individual marketplace

26 October 2022 - by Mike Hamachek, Scott Jones

Roughly two of three individuals would benefit by choosing an HSA plan over a comparable non-HSA plan.

Article

Comparing health insurance company surplus levels

27 August 2020 - by Scott Jones

This white paper discusses the basic elements of surplus, including its purpose, uses, and funding.

Article

Impacts of hurricanes on health outcomes and health insurance company operations

23 October 2017 - by Lynn F. Dong, Scott Jones, Michael J. Polakowski

From an operational and financial perspective, natural disasters can have significant effects on healthcare providers, insurers, and payers.

Article

Medical loss ratio (MLR) in the “Mega Reg”

27 June 2016 - by Jill Brostowitz, Scott Jones, Ian M. McCulla

While the Medicaid medical loss ratios (MLR) formula itself largely follows the commercial and Medicare Advantage (MA) MLR formula, there are key differences between the Medicaid minimum MLR standards and those currently established for the commercial and MA markets.

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Experience

Scott's actuarial experience includes pricing, rating, reserving, regulatory filings, and expert testimony, and he has worked with Veterans Healthcare, Medicare, and Commercial populations.

Recent projects include:

Participating on a team developing the Department of Veterans Affairs Enrollee Health Care Projection Model. Leading enrollment projections, including special populations and eligibility (e.g., VA Choice & MISSION, combat Veterans, community vs. VA facility patient distributions, etc.)
Analyzing the impact of legislation and administrative policies on the VA’s integrated health care system
Estimating Incurred But Not Reported (IBNR) claim liabilities
Certifying actuarial assets and liabilities on insurance company financial statements
Developing revenue recognition models for ASC 606, including conducting analysis of policy persistency
Developing commercial exchange filings and consulting; testing mental health parity
Conducting Medicare Advantage bid development
Preparing commercial and Medicare Advantage medical loss ratio (MLR) filings
Leading the firm’s weekly internal call on ACA-related pricing, filing, and regulatory matters for two years

Read their latest work

Article

米国の営利健康保険会社と非営利健康保険会社の比較：資本および剰余金の管理方法

10 December 2025 - by Scott Jones, Bill Miller

Article

Comparing for-profit and not-for-profit health insurers: How capital and surplus are managed

10 December 2025 - by Scott Jones, Bill Miller

How do for-profit and not-for-profit health insurers manage capital and surplus? We compare metrics such as the RBC ratio, net income, and growth of capital.

Article

Refining Medicare FFS expenditure projections in ACO REACH: Seasonality and completion

19 February 2025 - by Tyler Edwards, Scott Jones, Chris Smith

We review important considerations for accountable care organizations participating in Medicare’s ACO REACH model.

Article

PY2025 ACO REACH RTA tailwind

07 January 2025 - by Caroline Li, Scott Jones, Chris Smith

Performance-year 2025 for ACO REACH: The final retrospective trend adjustment is likely to be favorable for the benchmark.

Article

The retrospective trend adjustment: Looking back, looking forward

15 April 2024 - by Scott Jones, Chris Smith, Tabish Shaikh

REACH ACOs need to incorporate into financial projections another likely retrospective trend adjustment from the Center for Medicare and Medicaid Innovation.

Article

Oregon’s Health Care Cost Growth Target program: Implications of health plan penalties

11 October 2023 - by Scott Jones

We cover key considerations regarding Oregon’s Health Care Cost Growth Target program, including the potential financial and non-financial impacts for health plans.

Article

Proposed health savings account plan options in individual marketplace

26 October 2022 - by Mike Hamachek, Scott Jones

Roughly two of three individuals would benefit by choosing an HSA plan over a comparable non-HSA plan.

Article

Comparing health insurance company surplus levels

27 August 2020 - by Scott Jones

This white paper discusses the basic elements of surplus, including its purpose, uses, and funding.

Article

Impacts of hurricanes on health outcomes and health insurance company operations

23 October 2017 - by Lynn F. Dong, Scott Jones, Michael J. Polakowski

From an operational and financial perspective, natural disasters can have significant effects on healthcare providers, insurers, and payers.

Article

Medical loss ratio (MLR) in the “Mega Reg”

27 June 2016 - by Jill Brostowitz, Scott Jones, Ian M. McCulla

Scott Jones

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Experience

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Read their latest work

米国の営利健康保険会社と非営利健康保険会社の比較：資本および剰余金の管理方法

Comparing for-profit and not-for-profit health insurers: How capital and surplus are managed

Refining Medicare FFS expenditure projections in ACO REACH: Seasonality and completion

PY2025 ACO REACH RTA tailwind

The retrospective trend adjustment: Looking back, looking forward

Oregon’s Health Care Cost Growth Target program: Implications of health plan penalties

Proposed health savings account plan options in individual marketplace

Comparing health insurance company surplus levels

Impacts of hurricanes on health outcomes and health insurance company operations

Medical loss ratio (MLR) in the “Mega Reg”

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CHOOSE A LOCATION AND LANGUAGE

Scott Jones

Experience

Read their latest work

米国の営利健康保険会社と非営利健康保険会社の比較：資本および剰余金の管理方法

Comparing for-profit and not-for-profit health insurers: How capital and surplus are managed

Refining Medicare FFS expenditure projections in ACO REACH: Seasonality and completion

PY2025 ACO REACH RTA tailwind

The retrospective trend adjustment: Looking back, looking forward

Oregon’s Health Care Cost Growth Target program: Implications of health plan penalties

Proposed health savings account plan options in individual marketplace

Comparing health insurance company surplus levels

Impacts of hurricanes on health outcomes and health insurance company operations

Medical loss ratio (MLR) in the “Mega Reg”

CHOOSE A LOCATION AND LANGUAGE