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Actuarial Risk Adjustment Jobs in Florida (NOW HIRING)

Phsorg

Certify compliance with mental health parity quantitative treatment limits (Oversee commercial product risk adjustment submissions and validation) Governance & Talent Leadership Maintain actuarial ...

Deloitte

Health Actuary Consulting Manager

Miami, FL · On-site

... risk adjustment mechanisms, group insurance products, mergers and acquisitions, or health care ... As an Actuarial Manager, you will apply actuarial, strategic, and analytical experience to help ...

Deloitte

Health Actuary Consulting Manager

Tampa, FL

... risk adjustment mechanisms, group insurance products, mergers and acquisitions, or health care ... As an Actuarial Manager, you will apply actuarial, strategic, and analytical experience to help ...

Hannover Re

Sr Actuary

Orlando, FL · Hybrid

$113K - $205K/yr

... adjustment process. Summarize experience results and work with the AVP, Actuary, to improve the ... an Actuarial role Actuarial modeling experience: Risk Agility preferred Computer software:

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Actuarial Risk Adjustment information

What is actuarial risk adjustment?

Actuarial risk adjustment is a process used primarily in health insurance to make financial adjustments based on the underlying health status and expected costs of insured populations. This method helps ensure that insurance plans are fairly compensated for taking on higher-risk individuals, preventing insurers from only enrolling healthier people. By analyzing data such as age, gender, and medical history, actuaries create models that predict healthcare costs, which are then used to adjust payments or premiums. This supports fairness and sustainability in insurance markets while promoting access to care for all risk groups.

What are the key skills and qualifications needed to thrive as an actuarial risk adjustment specialist, and why are they important?

To thrive as an Actuarial Risk Adjustment Specialist, you need strong analytical abilities, a solid foundation in mathematics, statistics, or actuarial science, and typically a relevant degree or actuarial exam progress. Familiarity with data analysis tools like SAS, SQL, or Python, as well as knowledge of risk adjustment models and healthcare payment systems, is crucial. Exceptional attention to detail, problem-solving skills, and effective communication help professionals interpret complex data and explain findings to diverse stakeholders. These competencies ensure accurate risk assessments, drive fair reimbursement, and support data-driven decision-making in healthcare finance.

What are some common challenges faced in actuarial risk adjustment roles, and how can they be addressed?

Professionals in Actuarial Risk Adjustment often encounter challenges such as managing large and complex datasets, keeping up with evolving regulatory requirements, and ensuring the accuracy of risk score calculations. These challenges can be addressed by staying current with industry regulations, leveraging advanced analytical tools, and collaborating closely with data scientists, underwriters, and compliance teams. Continuous professional development and strong communication skills are also key to effectively navigating this dynamic environment.

What is the difference between Actuarial Risk Adjustment vs Actuarial Data Analyst?

AspectActuarial Risk AdjustmentActuarial Data Analyst
Required CredentialsActuarial exams, ASA or FSA designationTypically a bachelor's degree, some actuarial exams
Work EnvironmentInsurance companies, healthcare payers, government agenciesInsurance firms, consulting, healthcare organizations
Industry UsageFocuses on adjusting risk models for fairness and accuracyAnalyzes data to support actuarial models and business decisions

Actuarial Risk Adjustment specialists focus on modifying risk models to ensure fairness and accuracy in healthcare or insurance payments, often requiring advanced actuarial credentials. In contrast, Actuarial Data Analysts primarily analyze data to support actuarial models and business strategies, usually with less emphasis on actuarial certification. Both roles work within similar environments but serve different functions within the industry.

What are popular job titles related to Actuarial Risk Adjustment jobs in Florida?

For Actuarial Risk Adjustment jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Actuarial Risk Adjustment jobs in Florida look for?

The top searched job categories for Actuarial Risk Adjustment jobs in Florida are:

What cities in Florida are hiring for Actuarial Risk Adjustment jobs?

Cities in Florida with the most Actuarial Risk Adjustment job openings:

Actuarial Risk Adjustment jobs near you
Infographic showing various Actuarial Risk Adjustment job openings in Florida as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 10% Part Time, and 3% Contract. Highlights an 86% Physical, 5% Hybrid, and 9% Remote job distribution.

Director, Actuarial Services

Avalon Administrative Services LLC

Tampa, FL • On-site

Other

Posted 11 days ago

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


    • PM18


    PI38b853b018cc-37820-41268727

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