Jobs at Blue Cross & Blue Shield of Rhode Island

Leads enterprise content strategy and editorial development across consumer, stakeholder, digital, and traditional communications. Translates business priorities into compliant, audience-centered content; establishes editorial standards and governance; oversees web strategy, accessibility, UX, research, legal reviews, and multimedia content. Partners with cross-functional stakeholders to support growth, retention, member experience, brand trust, and operational effectiveness while managing complex editorial projects and mentoring others.

Leads enterprise transformation discovery engagements, identifying and evaluating opportunities involving AI, automation, digital capabilities, process innovation, and analytics. Facilitates research, workshops, and stakeholder collaboration; assesses feasibility, risk, complexity, ROI, and organizational impact; develops business cases, value hypotheses, recommendations, roadmaps, success metrics, and transformation strategies. Partners with executives, product, engineering, service design, and operations teams to prioritize high-value investments and guide initiatives from problem identification through future-state visioning.

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 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 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.

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.