Actuarial Analytics Director - Alternative Payment Models

Please email HR_Talent_AcquisitionTeam@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.

Bridge operational activities and financial processes, to enable accurate forecasting, financial reporting, and strategic decision-making. Partner closely with finance, contracting, and other business areas to ensure provider agreements and alternative payment models drive financial stability and support strategic and financial goals and mission. Lead actuarial support for risk adjustment and pharmacy rebate activities.

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  Lead actuarial support for provider contracting, including feasibility analysis of proposed alternative payment models and contract structures.

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  Model financial impacts to inform contract negotiations, network shifts, and proposed changes.

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  Forecast and monitor shared savings/losses, settlement outcomes, and downstream impacts of contracting decisions.

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  Support risk adjustment projections and financial modeling across submission cycles to inform revenue forecasting and planning.

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  Analyze and forecast quality incentive payments and rebate revenue based on utilization trends and contract terms.

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  Collaborate with finance to ensure actuarial outputs are integrated into financial planning models and ledger entries.

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  Identify and explain variance drivers from new membership and provider performance throughout the year.

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  Serve as a translation layer between operational functions, business areas, and finance, strengthening financial forecasting and alignment.

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  Perform other duties as assigned.

• Bachelor’s degree in Mathematics, Statistics, Economics or related field; or a combination of education and related work experience

• ASA or FSA designation from the Society of Actuaries

• Seven to ten years actuarial experience within the health insurance or related industry

• Prior experience pricing and evaluating alternative funding arrangements in healthcare.

• Medicare Advantage background

• Proven track record of partnering with finance and contracting functions to drive business results.

• Strong analytical, communication, and collaboration skills.

• Ability to present and translate complex data into digestible information.

• Experience with provider contracting, risk adjustment, and financial modeling preferred.

Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
   

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.

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