Avalon Administrative Services LLC

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 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 productsMonitor program performance, researching reasons for variances and providing/implementing actionable plansOversee medical cost trend analysis, utilization reviews, and per-member-per-month (PMPM) projectionsOwn the reserving process, including incurred but not reported (IBNR) liability estimates, claims development triangles, and variance analysesEnsure actuarial compliance with state and federal regulatory requirementsPartner with finance, health analytics, network management, and product teams to support pricing strategy and financial forecastingServe as the primary actuarial liaison with internal and external auditorsDirect the development of risk adjustment strategies and analyticsProvide executive leadership with clear, concise communication of actuarial findings, financial risk exposure, and strategic recommendationsDrive continuous improvement of actuarial models, tools, data infrastructure, and team workflowsMonitor industry trends, regulatory changes, and emerging healthcare cost drivers and communicate implications to leadershipLead 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 fieldAssociate of the Society of Actuaries (ASA) designation is required at minimumMember in good standing with the American Academy of Actuaries (MAAA) required5+ years of actuarial experience, with at least 5 years in a health plan or managed care settingDemonstrated expertise in healthcare actuarial pricing, reserving, or risk adjustmentStrong 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 membersUnderstanding of medical coding systems (ICD-10, CPT, HCPCS, DRG)Strong analytical, critical thinking, and problem-solving skillsExcellent written and verbal communication skills Director, Actuarial Services - Preferred Qualifications: 10+ years of actuarial experience in health insurance, managed care environmentExperience with risk adjustment and risk transferExposure to predictive modeling, machine learning applications in actuarial contexts, or health risk scoringExperience working with large-scale data platforms (Snowflake, Databricks, AWS)Experience with Tableau, Python or R for statistical analysisKnowledge of value-based care models (ACOs, PCMH, bundled payments)Understanding of HIPAA regulations and healthcare data governance practices PIe0eb7b996cd5-6692