Actuarial Analytics Director - Alternative Payment ModelsBlue Cross & Blue Shield of Rhode Island • United States
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Actuarial Analytics Director - Alternative Payment Models
Blue Cross & Blue Shield of Rhode Island
- United States
- United States
Über
Please email
HR_Talent_AcquisitionTeam@bcbsri.org
if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
Why This Job Matters 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.
What You Will Do
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.
What You Need To Succeed
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.
The Extras
Experience with provider contracting, risk adjustment, and financial modeling preferred.
Location
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.
BCBSRI is an equal opportunity employer.
The law requires an employer to post notices describing the Federal laws. Please visit www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.
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Sprachkenntnisse
- English
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