[Hiring] Director, Actuarial Services @Avalon Administrative Services LLC

Role Description

The Director, Actuarial Services is responsible for leading the organization's actuarial and healthcare analytics functions in support of strategic, financial, and operational objectives. This role directs the development and maintenance of actuarial models, financial forecasts, reserving methodologies, and risk analyses that support business performance and informed decision-making. Leveraging deep actuarial expertise and healthcare industry knowledge, the Director evaluates emerging trends, utilization patterns, medical cost drivers, and financial risks to provide actionable insights and recommendations.

The Director, Actuarial Services partners closely with executive leadership and cross-functional stakeholders, including Finance, Health Analytics, Network Management, and Product teams, to support pricing strategies, financial forecasting, risk adjustment initiatives, and regulatory compliance. This position is responsible for communicating actuarial findings, financial risk exposure, and strategic recommendations to leadership while driving continuous improvement of actuarial methodologies, tools, data infrastructure, and reporting capabilities. Through the application of advanced analytics and actuarial principles, the Director supports organizational performance, financial sustainability, and data-driven decision-making.

This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida.

Qualifications

• Bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related quantitative field
• Associate of the Society of Actuaries (ASA) designation is required at minimum
• Member in good standing with the American Academy of Actuaries (MAAA) required
• 5+ years of actuarial experience, with at least 5 years in a health plan or managed care setting
• Demonstrated expertise in healthcare actuarial pricing, reserving, or risk adjustment
• Strong proficiency in actuarial and analytical tools (e.g., Excel/VBA, Tableau, SAS, R, Python, or similar)
• Deep understanding of ACA regulations, CMS programs (Medicare Advantage, Medicaid)
• Exceptional communication and presentation skills with the ability to convey complex actuarial concepts to non-actuarial executives and board members
• Understanding of medical coding systems (ICD-10, CPT, HCPCS, DRG)
• Strong analytical, critical thinking, and problem-solving skills
• Excellent written and verbal communication skills

Requirements

• Direct the development and maintenance of actuarial models for all lines of businesses and products
• Monitor program performance, researching reasons for variances and providing/implementing actionable plans
• Oversee medical cost trend analysis, utilization reviews, and per-member-per-month (PMPM) projections
• Own the reserving process, including incurred but not reported (IBNR) liability estimates, claims development triangles, and variance analyses
• Ensure actuarial compliance with state and federal regulatory requirements
• Partner with finance, health analytics, network management, and product teams to support pricing strategy and financial forecasting
• Serve as the primary actuarial liaison with internal and external auditors
• Direct the development of risk adjustment strategies and analytics
• Provide executive leadership with clear, concise communication of actuarial findings, financial risk exposure, and strategic recommendations
• Drive continuous improvement of actuarial models, tools, data infrastructure, and team workflows
• Monitor industry trends, regulatory changes, and emerging healthcare cost drivers and communicate implications to leadership
• Lead ad hoc analyses and deep dives as required.

Preferred Qualifications

• 10+ years of actuarial experience in health insurance, managed care environment
• Experience with risk adjustment and risk transfer
• Exposure to predictive modeling, machine learning applications in actuarial contexts, or health risk scoring
• Experience working with large-scale data platforms (Snowflake, Databricks, AWS)
• Experience with Tableau, Python or R for statistical analysis
• Knowledge of value-based care models (ACOs, PCMH, bundled payments)
• Understanding of HIPAA regulations and healthcare data governance practices