Estimate risk-score related adjustments

Trigger: A financial reporting period ends or new member diagnosis data is consolidated for risk adjustment evaluation.

1. Extract member enrollment, demographic, and claims diagnosis data
2. Apply regulatory risk-scoring models to calculate individual member risk scores
3. Aggregate scores to determine the plan-level average risk profile
4. Estimate state and market-average risk scores and premiums
5. Calculate the estimated risk adjustment transfer amount
6. Compare estimates against historical trends and benchmarks
7. Record the estimated financial adjustment as a reserve or receivable

Outcome: An estimated risk adjustment payable or receivable is calculated and recorded in the financial ledger.