Pay Range:
$102,300.00 - $163,700.00
Please email if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
Why this job matters:
Plays a critical role in shaping the organization’s strategic direction by producing high‑quality financial insights that drive sound decision‑making. Lead the financial support for provider and vendor value‑based care modeling, risk adjustment analytics, and pharmacy rebate activities. Ensure alignment with organizational goals by collaborating effectively across teams, enhancing financial performance, ensuring compliance, and strengthening analytical capabilities across the organization.
What you will do:
- Lead financial modeling and analytics to support provider and vendor value‑based care (VBC) program design, performance monitoring, and contractual settlement analysis.
- Serve as the primary financial partner for risk adjustment forecasting, revenue optimization analyses, and scenario modeling.
- Oversee the analysis and reconciliation of pharmacy rebate performance, trends, and forecast inputs.
- Translate complex financial, actuarial, and clinical information into actionable insights for senior leadership.
- Partner with Actuarial, Clinical, Pharmacy, and Network Management teams to ensure alignment of financial methodologies and assumptions across the enterprise.
- Facilitate decision‑making by presenting financial scenarios, identifying risks, and recommending strategic pathways.
- Ensure adherence to financial, regulatory, and operational policies related to VBC, risk adjustment, and pharmacy programs.
- Develop and maintain standardized financial models, reporting tools, and documentation to support accuracy, transparency, and repeatability.
- Identify opportunities to streamline analytical workflows, improve data quality, and enhance forecasting and modeling accuracy.
- Other duties as assigned.
What you need to succeed:
- Bachelor’s degree in Finance, Accounting, Economics, Data Analytics, Healthcare Administration, Mathematics, or a related field (or equivalent experience).
- Seven to ten years of experience in financial analysis, healthcare analytics, actuarial support, or similar quantitative roles.
- Advanced proficiency in financial modeling, forecasting, and data analysis.
- Strong technical skills with tools such as Excel, SQL, Power BI/Tableau, or Python.
- Demonstrated ability to manage complex datasets and produce clear, actionable insights.
- Excellent communication skills, with the ability to simplify complex concepts for diverse audiences.
- Advanced proficiency in financial modeling, forecasting, and data analysis.
- Strong technical skills with tools such as Excel, SQL, Power BI/Tableau, or Python.
- Demonstrated ability to manage complex datasets and produce clear, actionable insights.
- Excellent communication skills, with the ability to simplify complex concepts for diverse audiences.
- Knowledge of Federal Acquisition Regulations and Cost Accounting Standards.
The extras:
- Experience with value‑based care financial models (shared savings, risk corridors, capitation, bundled payments, etc.).
- Familiarity with Medicare Advantage, commercial risk adjustment, HCC methodologies, or Part D revenue models.
- Knowledge of pharmacy rebate programs, PBM financial structures, and drug utilization analytics.
- Prior experience in a health plan, provider organization, or healthcare consulting environment.
- Project leadership experience, including guiding analysts or cross‑functional workstreams.
- Understanding of budgeting principles.
Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:
- In-office: onsite 5 days per week
- Hybrid: onsite 2-4 days per week
- Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
