Analytics + Actuarial
Precision in Risk.
Clarity in Outcomes.
HealthcareSystems provides actuarial and advanced analytics services for US healthcare payers and providers, combining credentialed actuarial expertise with production-grade data science.
Why HealthcareSystems?
Actuary-Led Engagements
Every project is directed by an FSA or ASA who is actively involved in model development—not just oversight.
Pre-Configured Healthcare Data Architecture
HIPAA-aligned data models covering claims, pharmacy, lab, EHR, and SDOH — ready for production on day one.
Proven Medicare Advantage Track Record
40+ bid submissions, 12 RADV defenses, and zero adverse RADV findings across our entire history.
Our Services
Comprehensive actuarial and analytics solutions tailored for Medicare Advantage, ACA, and Medicaid payers and providers.
Core Actuarial & Pricing
MA Bid Development, ACA Rate Filings, Medicaid Rate Setting, and reserving.
View DetailsRisk Adjustment & Coding
RAF Modeling, HCC Analytics, RADV Audit Support, and encounter data optimization.
View DetailsAdvanced Analytics & Data Science
Population Health, Claims Analytics, Stars Ratings, and ML/AI-driven tools.
View DetailsStrategic & Compliance
Financial Forecasting, Regulatory Impact Analysis, M&A Due Diligence, and Provider Analytics.
View DetailsProprietary Tools & Platforms
Production-grade software built by actuaries for healthcare payers.
RA Horizon Platform
Flagship SaaS for ongoing risk adjustment forecasting, suspect condition identification, and RAF optimization.
View DetailsBidCatalyst
MA bid modeling and scenario analysis tool—built for precise, audit-ready bid submissions.
View DetailsStarsTracker Dashboard
Real-time HEDIS/CAHPS monitoring with measure tracking and gap-closure recommendations.
View DetailsClient Analytics Portal
Secure, real-time dashboard for client access to custom reports, Stars projections, and utilization trends.
View DetailsOur Mission
"To deliver precise actuarial and analytical solutions that help U.S. healthcare payers and providers manage financial and clinical risk effectively."
Technical Excellence
Regulatory Integrity
Client Partnership
Measurable Results
Ready to improve your risk adjustment accuracy?
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