Jobs at Blue Cross & Blue Shield of Rhode Island

Lead financial modeling, forecasting, and analytics for value‑based care, risk adjustment, and pharmacy rebate programs. Partner with Actuarial, Clinical, Pharmacy, and Network teams to align methodologies, present scenarios to leadership, maintain standardized models and reporting, ensure compliance, and identify opportunities to improve data quality and forecasting accuracy.

Manage a Client Implementation team for large, complex self-funded accounts. Oversee onboarding/renewals, enrollment file processing (834/CSV), project plans, stakeholder communications, vendor integrations, policies/procedures, workload allocation, and issue resolution while developing staff and supporting pre-sales feasibility assessments.

Provide administrative and operational support to D‑SNP Case Management: member communications, data entry, report generation, scheduling, document translation and tracking, support clinical staff, ensure regulatory compliance, and assist with departmental projects and fulfillment.

Analyze, map, validate, and document enterprise data for the data warehouse. Work with business stakeholders and vendors to define requirements, source-to-target mappings, ELT processes, and data validation rules. Support SDLC activities, troubleshoot data quality issues, maintain user-facing data definitions and operational documentation, and assist with ingesting new data sources.

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.

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.

Provide care coordination for D-SNP members by completing HRAs and comprehensive assessments, developing and maintaining individualized care plans, coordinating benefits and interdisciplinary teams, educating members/caregivers, collaborating with providers and community resources, monitoring utilization and discharge planning, and supporting integrated care management.

Lead strategy and delivery for enterprise data, ELT, API, and AI platforms. Manage engineering and product teams to build scalable, secure data and integration capabilities, enforce governance and standards, optimize platform operations and vendor relationships, and drive cloud-native, CI/CD, and automation best practices to support analytics, interoperability, and AI use cases.

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.

Provide operational support for No Surprises Act processes (Open Negotiation and Independent Dispute Resolution), including case tracking, documentation, offer preparation, dispute documentation, cross-functional coordination, metric tracking, and assisting with reporting and analysis during high-volume periods.

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.

Support the Data, Analytics and AI team by creating learning materials, coordinating AI programs, and summarizing engagement insights. Assist in role-based AI training and content creation while promoting AI literacy.