Elvice Adji
AMERIHEALTH CARITAS
Lewiston,USA
2
Languages
20
years of professional experience
Data Scientist building predictive models and statistical solutions for healthcare cost estimation and optimization. Applies statistics, mathematics, Databricks, and business analysis to transform high-volume data into actionable analytics. Supports forecasting, process improvement, and stakeholder reporting across complex health data environments.
Work History
Contractor – Modeling and Data Science (Fully Remote)
7 Months- Using statistics, mathematics, modeling, business analysis, and technology such as Databricks to transform high volumes of complex data into advanced analytic solutions.
Senior Analyst (Fully Remote)
4 Years- Process Improvement – Analyzed current business processes and suggested improvements to increase efficiency and effectiveness.
- Assisted in the design, implementation, and evaluation of new processes for veteran healthcare cost estimates
- Created detailed business analysis, outlines, diagrams, and process flows
- Project Support – assisted in planning, monitoring, and controlling projects.
- Testing & Validation – Participated in testing, validation, and implementation of solutions.
- Developed and delivered presentations and reports to stakeholders and senior management.
- Oversaw predictive modeling processes for veteran healthcare cost estimates
- Led forecasting and predictive modeling initiatives to optimize veteran healthcare spending.
- Managed veteran healthcare cost through Advanced Medical Cost Management Solutions (AMCMS)
Health and Benefit Consultant – Actuary I
1 Year 11 Months- Actuarial Valuation – Conducted accounting disclosures, claims analyses, costings, projections, and periodic experience updates as required to assist in the financial management of clients’ insurance plans; and maintaining a variety of Excel-based group benefit actuarial tools
- Group Insurance Renewals & Financial Reports - conducted underwriting analyses based on clients’ plan history and change in risk for management to negotiate the best insurance rates possible on their behalf
- Provided critical support in negotiating reimbursement rates through detailed impact analysis.
- Performed market reviews and benchmarks to meet the evolving business needs of clients Provide renewal budget rates using Actuarial Modeling Suite (AMS)
- Ran IBNR (Incurred but Not Reported) models to estimate clients’ claim liabilities and set up reserves
- Provided monthly and quarterly Experience Monitoring Report (EMR) for medical, pharmacy and dental claim experience
- Developed and delivered presentations and reports to stakeholders and senior management.
Senior Actuarial Analyst
1 Year- Reviewed outstanding claim liabilities to assist in determining appropriate medical expenses and book reserves
- Responsible for ongoing development and maintenance of claim lag modeling system
- Set up and ran reserve models for the Florida (Prestige) Medicaid Line of Business
- Produced impact analysis regarding benefit and provider reimbursement changes, cost containment programs, on medical cost and trends.
- Developed and delivered presentations and reports to stakeholders and senior management.
Actuarial Analyst, Maine Pricing Team
4 Years 6 Months- Developed monthly EKM (Enterprise Key Metrics) reports based on Valuation and Cost of Care results to monitor Inpatient, Outpatient Professional and Pharmacy trends, and explain any unusual restatement in the trend
- Updated and Support Integrated Financial Trend (IFT) models to develop Pricing trends for Maine Large Group, Small Group, and Individual blocks of business
- Ran monthly risk score reports for Individual, Small Group and Large Group blocks of business
- Updated rating models for Individual, Small Group, and Large Group products
- Developed and delivered presentations and reports to stakeholders and senior management.
IT Procurement Analyst & Project Portfolio Consultant, Enterprise Vendor Management Office
7 Years 2 Months- Collaborated with stakeholders to understand business needs, goals, and challenges.
- Conducted market and competitor analysis to inform strategic decisions.
- Assisted in the design, implementation, and evaluation of new processes, systems, and products.
- Developed and delivered presentations and reports to stakeholders and senior management.
- Created detailed business analysis, outlines, diagrams, process flows, and use cases.
- Monitored and analyzed trends in company spending and inventory control to make recommendations for the future, and to identify areas for possible savings and/or asset optimization.
- Generated weekly and monthly reports including metrics that help senior leaders understand the financial performance of our vendors
- Played a data integrity role in the process of building the IT financial dashboard by collecting, verifying, and uploading financial data to Teradata tables, using SQL, VBA and SAS, in partnership with the data warehouse team
Education
- Passed Exams and Credits: P, FM, IFM, SRM, STAM, APC, VEE Corporate Finance, VEE Economics, and VEE Applied Statistics, FAP Modules 1-8, FAP Interim and Final Assessment
- Studying for Exam FAM and PA
Master of Science - Statistics
Bachelor of Science - Computer Information Systems
Skills
Actuarial Valuation
Actuarial Pricing
Healthcare Cost Analysis
Ibnr reserving
Claim reserve analysis
Advanced Statistical Modeling
SQL
Advanced Excel
Tableau
Predictive Modeling
Python programming
R programming
Languages
French
Native or Bilingual
English
Native or Bilingual
Timeline
Contractor – Modeling and Data Science (Fully Remote)
AMERIHEALTH CARITAS
01.2026 - CurrentRead More
Senior Analyst (Fully Remote)
TRIA FEDERAL
04.2021 - 04.2025Read More
Health and Benefit Consultant – Actuary I
AON
05.2019 - 04.2021Read More
Senior Actuarial Analyst
AMERIHEALTH CARITAS
05.2018 - 05.2019Read More
Actuarial Analyst, Maine Pricing Team
ANTHEM BLUECROSS BLUESHIELD
10.2013 - 04.2018Read More
IT Procurement Analyst & Project Portfolio Consultant, Enterprise Vendor Management Office
UNUM GROUP
08.2006 - 10.2013Read More
University of Maine at Augusta
Bachelor of Science from Computer Information Systems
Read More
University of Southern Maine
Master of Science from Statistics
Read More
Society of Actuaries
Read More