Job Description

About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is the nation’s leader in diagnostic intelligence, uniquely focused on transforming the role of diagnostic testing across the healthcare ecosystem. Our proprietary Diagnostic Insights Platform delivers evidence-based policies, curated lab networks, and real-time analytics that simplify complex diagnostics, accelerate innovation adoption, and optimize diagnostic investments.

Supporting over 30 health plans and 100 million members nationwide, Avalon partners with payers and providers to ensure diagnostic testing is performed appropriately, efficiently, and at the right time. Our flexible solutions span routine and genetic testing management, automated adherence, and end-to-end diagnostics support—driving measurable value, reduced waste, and improved clinical outcomes.

With unmatched scientific rigor, deep clinical expertise, and a performance-based model, Avalon is redefining how diagnostics power personalized care and healthcare value. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit www.avalonhcs.com

Avalon Healthcare Solutions is an Equal Opportunity Employer - Vet/Disability.

This position description is subject to change at any time. As determined by the company based upon business needs, an employee in this position may be required to perform duties and take responsibility for work other than as described in this document.

About the Director, Actuarial Services Position:

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.

Director, Actuarial Services – Essential Functions and Responsibilities:

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.

Director, Actuarial Services – Minimum 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

Director, Actuarial Services – 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

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Avalon Administrative Services LLC

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