Actuarial Analytics Director Alternative Payment Models

Pay Range:

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At BCBSRI our greatest resource is our people.

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 donot just for our members but for our employees as well.

We recognize that to do your best work you have to be your best self.
Its why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health dental and vision insurance as well as programs that support your mental health and well-being. We pay competitively offer bonuses and investment plans and are committed to growing and developing our employees.

Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where youre at in the organization youre an integral part of our team and your input thoughts and ideas are valued.

Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

Were dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality affordable and equitable care. To further improve the health and well-being of our fellow Rhode Islanders we regularly roll up our sleeves and get to work (literally) in communities all across the statebuilding homes working in food pantries revitalizing community centers and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can our associates receive additional paid time to volunteer.

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:

• Bachelors 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:
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 todays healthcare industry. BCBSRI is an equal opportunity employer.

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