Amy Giese

FSA, MAAA

Principal and Consulting Actuary

Brookfield, WI, US

Main +1 262 784 2250 | Office +1 262 796 3444

Amy Giese is a principal and consulting actuary with the Milwaukee office at Milliman. She joined the firm in 2011.

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Experience

With over 30 years of experience in the industry, Amy Giese has established herself as a seasoned expert in individual, small, and large group health insurance, including the ACA market, MEWA (Multiple Employer Welfare Arrangements), and level-funded plans. Her extensive background encompasses Medicare Part D bid development and support, pharmacy benefit management, provider benchmarking, and group dental insurance.

Amy has collaborated with commercial carriers on pricing strategies, projecting the impact of healthcare reform legislation, and managing financial and strategic risks. She has been instrumental in underwriting, product development, provider contract negotiations, and various actuarial projections. Her expertise extends to risk adjustment optimization, reserve valuation, claims auditing, rate filing assistance, and annual actuarial certifications.

In the Medicare market, Amy has supported Part D plans with strategic planning, formulary analysis, bid preparation, partnership analysis, and fraud, waste, and abuse monitoring. Her pharmacy-related projects include working with pharmacy benefit managers and retail pharmacies, formulary design, medication adherence outcome evaluations, and competitive analysis.

Amy's provider contracting experience involves collaboration with national provider management vendors to achieve corporate strategic planning and profitability objectives. These vendors include PBMs, specialty pharmacies, primary and passive rental PPO networks, radiology, laboratory services, and Centers of Excellence.

As an appointed actuary for various clients, Amy has demonstrated her ability to distill complex information into understandable insights for diverse audiences. She is known for challenging the status quo and introducing innovative methods to enhance actuarial processes. Amy is also a good listener, adept at understanding and addressing clients' needs effectively.

Professional Designations

Fellow, Society of Actuaries
Member, American Academy of Actuaries

Education

BS, Mathematics, University of Wisconsin Madison, 1993

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Publications

Read their latest work

Article

Every commercial health insurance issuer’s guide for understanding pharmacy benefit managers and medical loss ratio reporting

21 October 2020 - by Brandy N. Millen, Amy Giese, Jason Karcher

This article provides concrete examples of how pharmacy benefit manager (PBM) fees/margin, rebates, and quality improvement activities should be considered for calculating the medical loss ratio under different PBM arrangements.

Article

Are health carriers ready to explain the 2018 age curve?

16 November 2017 - by Amy Giese, Nicholas Krienke

For the first time since the inception of the Patient Protection and Affordable Care Act in 2014, the federal government is changing the age curve for ages 0 to 20, effective January 1, 2018.

Article

Remain, refile, or remove? The new 3 Rs: Considerations for 2018 commercial contingency planning

10 March 2017 - by Alison Fasching, Amy Giese

Issuers should develop contingency plans to evaluate the possible changes in the healthcare marketplace and identify the circumstances under which action is necessary.

Experience

Amy Giese

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Experience

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Read their latest work

Every commercial health insurance issuer’s guide for understanding pharmacy benefit managers and medical loss ratio reporting

Are health carriers ready to explain the 2018 age curve?

Remain, refile, or remove? The new 3 Rs: Considerations for 2018 commercial contingency planning

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Amy Giese

Experience

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