Director - Risk Management and Actuarial Services - Avera Health Plans

Location:

Avera Health Plans

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Position Highlights

This position is located in Sioux Falls, SD. Avera offers a re-location allowance.

Job Summary

The Director of Risk Management & Actuarial Services leads the risk assessment, actuarial analysis, and premium rating functions for Avera Health Plans. This role ensures financial sustainability and compliance while supporting pricing strategies, claims analysis, and forecasting for the health plan. The position collaborates with leadership to manage financial risks, optimize operations, and maintain regulatory compliance.

Requirements:

Bachelor's

Actuarial Science, Mathematics, Finance, or a related field

Required

Master's

Actuarial Science, Mathematics, Finance, or a related field

Preferred

Fellow of the Society of Actuaries (FSA) - Society of Actuaries (SOA)

or

Associate of the Society of Actuaries (ASA) - Society of Actuaries (SOA)

Certification in Enterprise Risk Management (CERA) - American Society for Health Care Risk Management (ASHRM)

4-6 years actuarial or risk management experience in the health insurance industry preferred

1-3 years leadership or management experience required

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

The Director of Risk Management & Actuarial Services leads the risk assessment, actuarial analysis, and premium rating functions for Avera Health Plans. This role ensures financial sustainability and compliance while supporting pricing strategies, claims analysis, and forecasting for the health plan. The position collaborates with leadership to manage financial risks, optimize operations, and maintain regulatory compliance.

What you will do

• Develop and implement strategies for identifying, evaluating, and mitigating financial and operational risks.
• Oversee risk management initiatives, including liquidity stress testing, and risk modeling and advise executives on risk exposure, financial stability, and long-term sustainability.
• Monitor industry trends, regulatory changes, and emerging risks to advise leadership on proactive measures.
• Lead the development of actuarial models to project claims, analyze trends, and support financial planning.
• Ensure accurate pricing strategies and rate filings in compliance with regulatory requirements.
• Provide actuarial support for underwriting, product development, and cost containment initiatives and collaborate with Finance and Operations to evaluate claims reserves.
• Drive decision-making by presenting clear, data-driven insights to leadership.
• Support strategic initiatives including new product development and expansions, by providing actuarial and risk analysis.
• Ensure compliance with state and federal regulations related to risk management and actuarial practices and act as a liaison with external auditors, regulators, and stakeholders on actuarial and risk matters.
• Lead, mentor, and develop a team of actuaries and risk management professionals.
• Responsibilities include interviewing, hiring, developing, training, and retaining employees; planning, assigning, and leading work; appraising performance; rewarding and coaching employees; addressing complaints and resolving problems.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

• Bachelor's Actuarial Science, Mathematics, Finance, or a related field
• Fellow of the Society of Actuaries (FSA) - Society of Actuaries (SOA) Upon Hire or
• Associate of the Society of Actuaries (ASA) - Society of Actuaries (SOA) Upon Hire
• 4-6 years Actuarial or risk management experience in the health insurance industry.
• 1-3 years Leadership or management experience.

Preferred Education, License/Certification, or Work Experience:

• Master's Actuarial Science, Mathematics, Finance, or a related field
• Certification in Enterprise Risk Management (CERA) - American Society for Health Care Risk Management (ASHRM)

Expectations and Standards

• Commitment to the daily application of Averas mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Averas values of compassion, hospitality, and stewardship.
• Uphold Averas standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO front-loaded for eligible hires

• Free health insurance options, for full-time single coverage on Avera High Deductible Health Plan

• Up to 5% employer matching contribution for retirement

• Career development guided by hands-on training and mentorship

Applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call ... or send an email to ... .