Director, Actuarial Services

Avalon Administrative Services LLC seeks a Director, Actuarial Services to lead actuarial strategy supporting risk adjustment, pricing, and quality programs for health plans and providers. This role designs and validates models using medical record, chart review, and claims data, ensuring accurate forecasting and regulatory compliance. The Director will translate complex analyses into clear recommendations, partner with data and operations teams, and guide financial and risk strategies.

You will mentor a small actuarial team while advancing Avalon's service-focused, patient-centered mission in a collaborative, professional environment.

Responsibilities

• Lead actuarial modeling and analysis for risk adjustment, pricing, and quality initiatives
• Develop and validate actuarial assumptions, methodologies, and forecasting models
• Oversee actuarial support for medical record retrieval and chart review programs
• Ensure compliance with regulatory and actuarial standards and support audit readiness
• Translate complex actuarial findings into clear insights for leadership and clients
• Partner with data, operations, and clinical teams to improve risk and quality outcomes
• Guide financial projections, scenario analysis, and portfolio performance reporting
• Build and maintain actuarial dashboards, KPIs, and performance metrics
• Lead, mentor, and develop actuarial staff and analysts
• Contribute to strategic planning, product development, and process improvement

Required Skills

• Health actuarial analysis
• Risk adjustment modeling (HCC, RAF)
• Healthcare claims and clinical data analytics
• Pricing and financial forecasting
• Actuarial modeling software (e.g., SAS, R, Python)
• SQL and data querying
• Regulatory compliance for health plans
• Predictive modeling and statistics
• Reporting and data visualization tools (e.g., Power BI, Tableau)
• Team leadership and stakeholder communication