Blue Cross & Blue Shield of Rhode Island · 1 day ago
Actuarial Analytics Director - Alternative Payment Models
United States
Full-time
Onsite
Mid, Senior Level
$160K/yr - $266K/yr
7+ years expBlue Cross & Blue Shield of Rhode Island (BCBSRI) is dedicated to improving the health and well-being of Rhode Islanders. The Actuarial Analytics Director will bridge operational activities and financial processes to enable accurate forecasting and strategic decision-making, while leading actuarial support for provider contracting and alternative payment models.
Insurance
Responsibilities
Lead actuarial support for provider contracting, including feasibility analysis of proposed alternative payment models and contract structures
Model financial impacts to inform contract negotiations, network shifts, and proposed changes
Forecast and monitor shared savings/losses, settlement outcomes, and downstream impacts of contracting decisions
Support risk adjustment projections and financial modeling across submission cycles to inform revenue forecasting and planning
Analyze and forecast quality incentive payments and rebate revenue based on utilization trends and contract terms
Collaborate with finance to ensure actuarial outputs are integrated into financial planning models and ledger entries
Identify and explain variance drivers from new membership and provider performance throughout the year
Serve as a translation layer between operational functions, business areas, and finance, strengthening financial forecasting and alignment
Perform other duties as assigned
Qualification
Required
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
Preferred
Experience with provider contracting, risk adjustment, and financial modeling preferred
Benefits
Flexible work arrangements that include remote and hybrid opportunities
Paid time off
Tuition reimbursement
Assist with student-loan repayment
Health, dental, and vision insurance
Programs that support your mental health and well-being
Competitive pay
Bonuses
Investment plans
Additional paid time to volunteer
Company
Blue Cross & Blue Shield of Rhode Island
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), we know that health is more than what happens at the doctor’s office.
501-1000 employees
H1B Sponsorship
Blue Cross & Blue Shield of Rhode Island has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (4)
2024 (4)
2023 (2)
2022 (4)
2021 (3)
Funding
Current Stage
Late StageLeadership Team
Martha Wofford
President and CEO
James Joy
Chief Financial Officer - Retired
Company data provided by crunchbase