Director, Actuarial Services
On-siteTampa, Florida, United States
Job Summary
Direct the development and maintenance of actuarial models, reserving methodologies, and risk analyses for all business lines and products. Monitor program performance, medical cost trends, and utilization reviews to provide actionable plans and projections. Own the reserving process, including IBNR estimates and variance analyses, while ensuring compliance with state and federal regulatory requirements. Partner with finance, health analytics, network management, and product teams to support pricing strategies, financial forecasting, and risk adjustment initiatives. Serve as the primary actuarial liaison with internal and external auditors, driving continuous improvement of tools, data infrastructure, and reporting capabilities. Communicate actuarial findings and financial risk exposure to executive leadership. This role requires quarterly travel to the Tampa, Florida corporate office.
Required Qualifications
- Bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related quantitative field
- Associate of the Society of Actuaries (ASA) designation
- Member in good standing with the American Academy of Actuaries (MAAA)
- 5+ years of actuarial experience
- 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
- This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida
Desired 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
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