Actuarial Analytics Director - Alternative Models

Pay Range: $ - $
Reasonable Accommodation: If you require a reasonable accommodation for the application and interview process, please email _Acquisition

Team.

Bridge operational activities and financial processes to enable accurate forecasting, financial reporting, and strategic decision‑making. Partner with finance, contracting, and other business areas to ensure provider agreements and alternative payment models drive financial stability and support strategic and financial goals of the organization. Lead actuarial support for risk adjustment and pharmacy rebate activities.

• 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.

• 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.

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

BCBSRI is headquartered in downtown Providence, Rhode Island. The role offers remote, hybrid, or in‑office options. Remote candidates must reside in one of the following states:
Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia.

BCBSRI is an equal‑opportunity employer. The law requires employers to post notices describing the Federal laws. Please visit (Use the "Apply for this Job" box below). to view the “Know Your Rights” poster.