Operations Analyst, Senior - Hybrid

This is a full-time hybrid position based in the Pittsburgh area.

About the role

This role oversees administrative, system processes, and special projects related to the implementation and maintenance of the claims transactional system as well as other applications for all UPMC Health Plan products. Under the general direction of the Business Support Management team, the Operations Analyst, Senior 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 to improve clinical and financial performance, articulate these opportunities to internal and external audiences, implement solutions, and track progress. The position also involves taking a leadership role in the enhancement, development, documentation, and communication of identified variances while considering practical barriers to implementation.

Responsibilities

• Maintain employee/insured confidentiality
• Perform other duties as assigned
• Complete inquiries generated from the data reporting and analysis area
• Participate in training programs when available/as requested
• Provide support to Operations Analysts
• Complete Executive Summary management documentation as required
• Actively identify and implement work process improvements to enhance team performance
• Assist other departments during periods of backlogs
• Perform in accordance with system-wide competencies/behaviors
• Maintain and update MC400 enhancement log and tracking form; document specifications for system enhancements on appropriate forms, retaining data on department share drive; ensure all activities are appropriately monitored and resolved timely
• Manage special projects as assigned by the Management team; develop/maintain project plans, as needed
• Attend meetings on behalf of Manager/Director
• Interface with customers by telephone, correspondence, and/or in person to answer inquiries and resolve concerns/issues
• Manage, update, and maintain source data dictionaries as they relate to processes
• Model business requirements for new systems, special projects, and enhancements to existing systems; validate and test fixes/enhancements to new and existing systems
• Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork
• Take a leadership role in mentoring and motivating staff to build a strong, cohesive team
• Administer, identify, test, audit, and implement new processes on transactional claims systems
• Meet deadlines and turnaround times set by Management staff, which may require working extended hours until project completion
• Identify areas of concern that may compromise client satisfaction through data analysis and propose solutions based on findings, expertise, and research
• Identify appropriate resources and support needed to facilitate decisions to achieve optimal outcomes

Requirements

• Bachelor's Degree or equivalent work experience
• Minimum five years of general business experience
• Experience in health care insurance or 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
• 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