Operations Analyst, Intermediate - Hybrid

UPMC Health Plan has an exciting opportunity for an Operations Analyst, Intermediate position in the Core System Operations department. This is a full-time hybrid position based in the Pittsburgh area.

This role oversees administrative, system processes and special project as they relate to identification, implementation and maintenance of the claims transactional system and other applications for all UPMC Health Plan products. Under the general direction of the Business Support Management team, this role will analyze, identify, propose and implement solutions for all business areas. Acts as subject matter expert supporting all areas and interact with staff to answer questions and resolve issues as they arise.

The Operations Analyst, Intermediate must use their knowledge and understanding of financial, clinical and other information generated by numerous sources to identify opportunities to improve clinical and financial performance. Furthermore, the position requires the ability to articulate these opportunities to internal and external audiences, implement the solutions, and track and monitor progress. Will take a leadership role in the enhancement, development, documentation, and communication of identified variances.

These functions must be done while also weighing the practical considerations and potential barriers that need to be overcome to successfully implement new programs and processes. To successfully perform the role, must understand the causes of financial & clinical trends and anomalies.

Responsibilities:

+ Interface with customers by telephone, correspondence, and or in person to answer inquiries and resolve concerns/issues

+ Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork

+ Effectively prioritize and complete all assigned tasks

+ Identify areas of concern that may compromise client satisfaction through data analysis, and propose solutions based on findings, expertise, and research

+ Maintains departmental Policy and Procedure documentation; completes annual policy review making necessary updates as required

+ Participates in training programs when available/as requested

+ Assists other departments during periods of backlogs

+ Manages special projects as assigned by Management team; develops/maintains project plans, as needed

+ Administer, identify, test, audit, and implement new processes on transactional claims systems

+ Model business requirements for new systems, special projects and enhancements to existing systems; validate and test fixes/enhancements to new and existing systems

+ Allocates the Operations Analysts time appropriately to meet production and quality standards

+ Trains new and existing employees on departmental policies and procedures

+ Attends meetings on behalf of Management team

+ Maintains employee/insured confidentiality

+ Performs other duties as assigned

+ Manages, updates, and maintains source data dictionaries as they relate to processes

+ Completes inquiries generated from the data reporting and analysis area

+ Provides support to Operations Analysts

+ Performs in accordance with system-wide competencies/behaviors

+ Completes Executive Summary management documentation as required

+ Bachelor's Degree or equivalent work experience.

+ Minimum four years general business experience.

+ Experience in health care insurance or health care industry preferred, but those with relevant experience in other industries will be considered

+ Knowledge of Commercial, Medicaid, Medicare and Individual products preferred.

+ Competence in MS Office required, including MSExcel, MSAccess, MSWord.

+ Competence of the most common features of specialized analysis and reporting tools, e.g. SQL, SSIS, Oracle, and MS Office Suite.

+ Excellent planning communication, documentation, analytical and problem-solving abilities.

+ Ability to work in a fast-paced environment.

+ Must possess strong interpersonal, organizational, and project management skills, with the ability to work on multiple tasks simultaneously.

+ Experience in QA/Audit/Systems testing development and execution preferred. Licensure, Certifications, and Clearances:

- ACT 34

UPMC is an Equal Opportunity Employer/Disability/Veteran