Ross A. Winkelman FSA, MAAA, is a Principal and the Vice-President of the Denver office of Wakely Consulting Group. He joined the firm in January of 2007 to open the Denver office and has worked as a health actuary for over 16 years. Prior to joining Wakely, Ross worked at two different insurance companies, an audit firm and was a Principal at Milliman. He specializes in publicly sponsored managed care programs including Medicaid, Medicare, and CHAMPUS.
Ross represents five health plan associations in their Medicaid rate negotiations. He is the certifying actuary for the Colorado Medicaid managed care program and the Massachusetts Connector Commonwealth Care (health reform) program. Ross led the development of the risk adjustment methodology for the Arizona Medicaid managed care and Massachusetts Connector Commonwealth Care programs. He has experience working with Medicaid managed care capitation rates in the following states: Arizona, California, Colorado, Florida, Hawaii, Illinois, Indiana, Louisiana, Michigan, Mississippi, Missouri, Nebraska, New Mexico, New York, Ohio, Oregon, Pennsylvania, and South Carolina.
Ross has filed Medicare bids on behalf of Medicare Advantage managed care companies for the last four years. He has experience on litigation projects and also has experience working on mergers, including several projects in Brazil. Ross led a team of actuaries and accountants in auditing Medicare filings for the Center for Medicare and Medicaid Services (CMS). He has worked on triennial examinations of insurance companies on behalf of state insurance departments and has experience estimating liabilities in support of financial statement audits and litigation cases. Ross led two separate research projects for the Society of Actuaries (SOA), one on the commercially available risk adjustment software tools, and one on provider network risk.
Ross has advised CMS, states, insurance companies, military health services companies, PHOs, HMOs, PPOs, and other managed care organizations. He has developed rating models for many health plans, including developing the rating structures for the Chilean ISAPRE system.
Ross is an elected member of the Society of Actuaries (SOA) Health Section Council, and the chair of the SOA’s Health Section Research committee. He is also the former Editor for the SOA Health Section’s newsletter (Health Watch), former vice-chair of the SOA’s Communications and Publications sub-committee, and a former member of the Society of Actuaries managed care exam committee. Ross was a contributing author for the book, “True Group Long Term Care”.
Ross is currently leading a committee that is developing a Risk Adjustment Actuarial Standard of Practice (ASOP) for the American Academy of Actuaries’ Actuarial Standards Board (ASB).