Issue/opportunity

Amid sustained net operating losses, declining premium revenue, and looming ORSA compliance requirements, a regional health insurer engaged our team (following a competitive RFP) to evolve its Enterprise Risk Management (ERM) program into a strategic lever for performance improvement and regulatory alignment.

Approach & outcomes

• Conducted an ERM cultural readiness survey to assess organizational maturity and advised initiating a comprehensive enterprise risk assessment to prioritize risks across the business.
• Designed and implemented an ORSA-aligned ERM framework to both satisfy NAIC compliance and establish a scalable structure for enterprise risk monitoring and decision-making.
• Formed and operationalized a board-level risk committee and developed governance tools to enable strategic oversight of enterprise-wide risks by board and executive leadership.
• Outcomes over subsequent years included:
  
  • 8-10% growth in premium revenue under unchanged underwriting criteria, driven by stronger portfolio management and reduced adverse selection.
  • 3-5 percentage point improvement in Medicare Loss Ratio (MLR) through enhanced chronic care management and more effective value-based provider contracts.
  • 4-6% increase in Medicare Risk Adjustment revenue, resulting from more accurate coding and improved documentation practices.
  • 15-20% improvement in risk-based capital ratio, reflecting strengthened balance sheet stability and improved risk governance discipline.