Jobs at Blue Cross & Blue Shield of Rhode Island

Leads medium- to large-scale IT and operational projects within the EPMO. Develops project plans and transformation roadmaps, manages budgets, resources, vendors, risks, and timelines, and coordinates cross-functional teams. Communicates with stakeholders and executives, facilitates steering committees, tracks performance metrics, ensures compliance, and delivers business and technology solutions aligned with strategic objectives.

Engineers, implements, optimizes, automates, and supports enterprise database and cloud data platforms. Designs secure, highly available solutions across SQL Server, Azure, PostgreSQL, Oracle, Snowflake, and analytical technologies; provides Level 3 production support; leads modernization, cloud migration, performance optimization, disaster recovery, security, governance, and automation initiatives. Partners with architects and operations teams, develops standards and runbooks, troubleshoots critical incidents, supports CI/CD and data integration, and mentors technical staff.

Provides clinical pharmacy expertise for a health insurer, supporting pharmacy benefit management, formulary compliance, utilization review, cost containment, and medication appropriateness. Reviews prescriptions, analyzes pharmacy data, advises physicians, develops cost-effective pharmacy programs, supports disease management, and educates internal teams on pharmacy benefits and policies. Requires pharmacist licensure, managed care knowledge, and experience with Medication Therapy Management and Medicare Stars.

Provides clinical pharmacy expertise for Medicare and Medicaid programs within an interdisciplinary managed-care environment. Reviews prescriptions for appropriateness, formulary compliance, benefit policy alignment, and regulatory requirements. Develops cost-effective pharmacy programs and member care plans, analyzes prescription data, supports utilization review and disease management, educates providers and internal teams, and advises on pharmacy policies and regulatory issues.

Lead sales and account management for the Under 100 commercial market (Small Group <50 and Large Group 50-99). Oversee Account Executives and a general agent, drive new business, retention, and enrollment targets, manage broker relationships, set performance metrics, collaborate cross-functionally, and coach a high-performing team.

Lead architectural direction across multiple domains, owning high-complexity solution designs, governance, and enterprise standards. Mentor architects, produce HLDs and technical artifacts, evaluate trade-offs, drive build/buy decisions and POCs, ensure scalability, security, and observability, and align technology strategy with business outcomes across project lifecycles.

Lead design, development, and maintenance of Power BI dashboards and self-service analytics. Translate stakeholder requirements into clear visualizations, collaborate with data engineering, write and optimize SQL and DAX, ensure data accuracy and performance, document models and assumptions, apply visualization best practices, and evolve dashboards using user feedback and AI tools.

Lead solution and technical architecture for medium-to-high complexity systems. Produce HLDs and design artifacts, evaluate trade-offs, run POCs, enforce enterprise standards, ensure scalability/resilience, mentor junior architects, manage risks/assumptions, and align solutions with business, compliance, and EA principles throughout the project lifecycle.

Lead and manage the payment integrity department, overseeing claims audit and recovery programs, vendor relationships, financial reporting of recoveries, workplan/resource scheduling, provider liaison and education, and cross-functional strategic initiatives to improve member/provider satisfaction and financial performance.

Lead the unit that resolves member and provider grievances and appeals across all products. Oversee staff and first-line managers, ensure regulatory/CMS compliance, manage reporting and program metrics, drive quality improvement and policy updates, coordinate resolutions, develop goals and budgets, and mentor teams to meet performance targets.

Lead technical execution of a Salesforce delivery pod across Sales, Service, and Configuration workstreams. Provide hands-on development, architecture guidance, code and config reviews, CI/CD and release management, integration and data migration oversight, production troubleshooting, security and governance adherence, and mentor team members to ensure high-quality agile delivery.

Lead QA strategy and execution for a Salesforce delivery pod, coordinating functional, integration, regression, and release testing across Sales, Service, and configuration workstreams. Define test plans, manage defects, validate Salesforce configuration and integrations, support CI/CD and deployment verification, mentor QA team members, and ensure compliance, data integrity, and release readiness across connected enterprise systems.

Lead end-to-end transformation for a business domain, translating opportunities into roadmaps and measurable outcomes. Partner with business leaders, AI discovery, analytics, and engineering to design, pilot, and scale integrated technology and process solutions. Drive adoption, behavior change, financial and operational results, manage stakeholders and tradeoffs, and enable sustained performance improvements. May include platform integration, customization, and AI-driven solutions.

Support actuarial and financial functions for pharmacy benefit programs by analyzing claims, utilization, cost trends, and financial performance. Build statistical and actuarial models for pricing, forecasting, and reserve adequacy. Extract and analyze data from databases, prepare regulatory reports, and participate in projects and departmental initiatives.