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Role Description

This role involves bridging operational activities and financial processes to enable accurate forecasting, financial reporting, and strategic decision-making.

• 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.

Qualifications

• 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

Requirements

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

Benefits

• Flexible work arrangements including remote and hybrid opportunities
• Paid time off
• Tuition reimbursement and assistance with student-loan repayment
• Health, dental, and vision insurance
• Programs that support mental health and well-being
• Competitive pay, bonuses, and investment plans
• Additional paid time to volunteer in the community

Company Description

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.

• Our culture is one of belonging, striving for transparency and accountability.
• We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences.
• We’re dedicated to serving Rhode Islanders through community engagement and volunteer work.