Member Profile

Tony Pistilli is a consulting actuary with Axene Health Partners. Tony has worked as a health care actuary for over 10 years, bring expertise in claims data analytics, predictive modeling and data science, and medical coding. Prior to joining AHP, Tony was Director of Analytics for Optum’s Payment Integrity product where he led a team of actuaries and data scientists who identified and developed analytics to stop emerging fraud, waste, abuse, and coding error issues. Tony’s team was also responsible for developing savings estimation models and designing and assisting in negotiating payer contracts. In other roles at UnitedHealth Group, Tony led healthcare economics teams for Optum Behavioral and OptumCare, was the founding actuary on the Corporate Treasury department’s Enterprise Risk Management team, and completed pricing and rate filing activities for Optum’s Employer Stop Loss product. Tony has also worked as a consulting actuary at Mercer’s Government Health Services organization, where he was responsible for managing rate setting, 1115 waiver demonstration, and Mental Health Parity evaluation projects, as well as with Santa Barbara Actuaries, where he assisted clients with development of novel risk adjustment methodologies, Medicare Advantage market strategy development, and claims data analytics and value demonstrations. Tony and his wife live in Madison, WI and have 4 children. He holds a Bachelor of Arts degree in Actuarial Science from the University of Wisconsin, Eau Claire, is a Fellow of the Society of Actuaries, a Member of the American Academy of Actuaries, and a Certified Enterprise Risk Analyst. He is a frequent author and presenter at actuarial conferences, presenting on topics ranging from emerging data science technologies, pharmaceutical patent regulation, and medical coding.