Business Configuration Solutions Analyst Senior -Cognizant Implementations (Hybrid)

About the role

As a Senior Business Configuration Solutions Analyst at UPMC Health Plan, you'll play a critical role in shaping how the organization's core systems support its products, members, and operations.

Responsibilities

• Lead the administration, configuration, testing, auditing, and implementation of transactional claims processes for internal clients and third-party administrators (TPA).
• Support CAPS modernization and migration to Cognizant QNXT, including configuration buildout, testing, conversion validation, and go-live readiness.
• Translate business requirements into system designs and enhancements, ensuring alignment with operational and customer needs.
• Drive solution selection by conducting vendor research, supporting Request for Proposals (RFPs), facilitating demos, and defining evaluation criteria.
• Collaborate across business, IT, security, compliance, legal, and contracting teams to review requirements and ensure alignment.
• Audit business requests to confirm configurations comply with plan design, schedules of benefits, and reimbursement requirements.
• Analyze data to identify risks, trends, or gaps that may impact client satisfaction, compliance, or financial outcomes, and propose actionable solutions.
• Work closely with developers and testers to ensure requirements are accurately translated into functional technical solutions.
• Manage requirements gathering, prioritization, and negotiation to ensure delivered solutions meet or exceed expectations.
• Support system integration activities related to CAPS-to-QNXT migration, including coordination, testing validation, and production readiness.
• Identify root causes of issues, assess member and financial impact, and implement effective resolution strategies.
• Ensure controls are in place and monitored to meet regulatory standards and UPMC policies.
• Maintain and annually review departmental policies and procedures, making updates as needed.
• Take an active mentorship role by coaching, developing, and supporting team members.
• Participate in enterprise-wide initiatives and perform additional duties as assigned.

Requirements

• Hands-on experience with Core Administration Processing Systems, specifically Cognizant QNXT.
• Proven experience supporting or leading system migrations (legacy platforms to QNXT), including data mapping, configuration, testing, and validation.
• Strong understanding of claim adjudication logic, pricing methodologies, coordination of benefits (COB), and payment integrity.
• Proficiency in SQL or similar query tools for research, validation, and troubleshooting.
• Working knowledge of EDI transactions (837, 835, 834, 820, 270/271).
• Experience using requirements and work management tools such as Jira, Azure DevOps, ServiceNow, and Confluence.

Qualifications

• Bachelor's Degree or equivalent work experience.
• Minimum of 6 years general business experience.
• Understanding of XML data structure.
• 3 or more years of experience with Core Administration Processing Systems, specifically Cognizant QNXT is highly preferred.
• Hands-on experience supporting or leading a system migration (e.g., legacy platform → QNXT), including data mapping, configuration buildout, conversion validation, and parallel testing.
• Strong understanding of claim adjudication logic, pricing methodologies, COB, and payment integrity functions highly preferred.
• Proficient in SQL or similar query tools for data validation, research, and troubleshooting.
• Familiarity with EDI transactions (837, 835, 834, 820, 270/271) highly preferred.
• Experience using requirements management tools (Jira, Azure DevOps, ServiceNow, Confluence) highly preferred.

Skills

• Complex problem-solving skills.
• Leadership and influence skills.
• Collaborative mindset.
• Technical communication skills.

Benefits

Hybrid role with a 3-day in-office requirement.

Pay

Details TBD.

Schedule

Hybrid role with a 3-day in-office requirement.