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.

Prepare and maintain subscriber agreements and benefit booklets ensuring regulatory compliance and accuracy. Update templates, manage subscriber agreement database, respond to internal partners, produce inventory reporting, support custom implementations, research historical account data for litigation, and participate in projects to streamline document production.

Conduct in-depth analyses of claim payments, identify trends, ensure compliance with guidelines, propose solutions, and manage audits and recoveries.

Lead BCBSRI's corporate strategy and corporate development functions, advise executive leadership, identify and evaluate growth and partnership opportunities, and drive execution of strategic initiatives across the organization to achieve long‑term value and alignment with board and corporate priorities.

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 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 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 actuarial support for provider contracting and alternative payment models, ensuring accurate financial reporting and strategic forecasting. Collaborate with finance to analyze impacts and guide decision-making processes.

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.

Lead design and implementation of secure, scalable AI integrations across enterprise systems. Build, tune, and deploy ML/LLM models and MLOps pipelines, manage data preparation and observability, advise on AI strategy and governance, mentor engineers, and collaborate with cross-functional teams to deliver AI-driven solutions.

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.

Negotiate, implement, and administer complex hospital, physician group, ancillary, and vendor contracts to meet financial and business objectives. Monitor contract compliance, educate and liaise with provider partners, lead projects, mentor contract administrators, analyze financial and quality data, and recommend changes to improve performance and compliance.

Design, administer, and improve employee health, retirement, voluntary, and wellbeing programs. Own Workday benefits configuration, testing, maintenance, and digital enablement. Ensure compliance with ERISA/ACA/HIPAA, coordinate audits/filings, manage vendor relationships, and use analytics and automation to drive adoption and operational efficiency. Advise HR partners and mentor colleagues to align wellbeing with business strategy.