Operations Analyst, Intermediate - Hybrid

Full-time hybrid position based in the Pittsburgh area.

About the role

This role oversees administrative and system processes, as well as special projects related to the 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, the Operations Analyst will analyze, identify, propose, and implement solutions for all business areas. Acts as a subject matter expert supporting all areas and interacts with staff to answer questions and resolve issues. The role requires using knowledge of financial, clinical, and other information to identify opportunities for improving clinical and financial performance, articulate these opportunities to internal and external audiences, implement solutions, and track progress. The position also involves leadership in the enhancement, development, documentation, and communication of identified variances while considering practical barriers to implementation.

Responsibilities

• Interface with customers by telephone, correspondence, 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.
• Maintain departmental Policy and Procedure documentation; complete annual policy review and make necessary updates as required.
• Participate in training programs when available or as requested.
• Assist other departments during periods of backlogs.
• Manage special projects as assigned by the Management team; develop and maintain 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.
• Allocate time appropriately to meet production and quality standards.
• Train new and existing employees on departmental policies and procedures.
• Attend meetings on behalf of the Management team.
• Maintain employee/insured confidentiality.
• Perform other duties as assigned.
• Manage, update, and maintain source data dictionaries as they relate to processes.
• Complete inquiries generated from the data reporting and analysis area.
• Provide support to Operations Analysts.
• Perform in accordance with system-wide competencies/behaviors.
• Complete Executive Summary management documentation as required.

Requirements

• Bachelor’s Degree or equivalent work experience.
• Minimum four years of general business experience.
• Experience in health care insurance or the health care industry preferred, but candidates with relevant experience in other industries will be considered.
• Knowledge of Commercial, Medicaid, Medicare, and Individual products preferred.
• Competence in MS Office required, including MS Excel, MS Access, and MS Word.
• Competence in 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.
• 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