UPMC Health Plan is hiring a full-time Systems Analyst – Intermediate to join the Quality Assurance and Operation Integrity team. This position follows a hybrid work schedule.
The ideal candidate will have experience extracting and analyzing claims data, identifying trends and discrepancies, and supporting data-driven decision-making. Prior experience working with healthcare claims data and using SQL to query, validate, and analyze large data sets is strongly preferred.
Candidates must be legally authorized to work in the United States, without requiring, now or in the future, sponsorship for employment visa status. UPMC does not participate in STEM OPT.
Responsibilities:
- Extract, analyze, and validate large healthcare claims datasets using SQL and other reporting tools.
- Investigate claim payment discrepancies, adjudication issues, provider configuration concerns, and operational risks.
- Support payment integrity, audit, compliance, and special project reviews through detailed claims analysis.
- Identify trends, anomalies, and opportunities for process improvements through quantitative analysis.
- Collaborate with business stakeholders to define data requirements and develop reporting solutions.
- Documentation: Complete documentation/flow charting of system builds and maintain team's existing documentation independently. Responsible for validating current documentation. Extract and document customer/business requirements and needs for use by enterprise architecture and engineering teams (network, system, and software).
- Second and Third Level Support (Including Maintenance Activities): Independently triage and resolve level 1 and level 2 support issues. Escalate level 3 support issues accordingly.
- Project Management: Create and contributes to project tasks and milestones. Update all project management and time tracking tools accordingly. Ability to take full ownership of a project.
- SDLC (System Development Life Cycle): Have an intermediate understanding of the application development life cycle. Ability to apply those principles to day-to-day work.
- Data Confidentiality/Security: Maintain confidentiality of sensitive information at all times.
- Data Quality: Maintain data quality at all times.
- Vendor Relationships: Interact with vendors (technical issues, project initiatives) under the direction of more experienced team members as necessary. Assist with issue escalation where applicable.
- Report Writing/Analysis: Write, analyze and make modifications to reports either independently for basic requests or under the direction of more experienced team members for more complex requests.
- End User Training: Create and review existing training documentation. Facilitate high-level user training sessions independently.
- Process Improvement: Create and update processes. Ability to contribute to process improvement efforts.
- Application Upgrades and Implementation: Review and validate functionality of application upgrades and implementations. Report back on any problems. Identify new functionality and/or hardware requirements as assigned. Ability to create test plans.
- System Integration: Complete assigned tasks related to system integration. Validate testing. Ability to modify existing test plans.
- Communication: Responsible for demonstrating appropriate, clear, concise, and effective written and oral communications in all interactions to build relationships and accomplish day to day work and projects.
- Interactions with Others: Successfully completes projects, tasks, and initiatives by embracing a team-first approach. Works in collaboration with team and offers feedback, where appropriate, to complete individual and group efforts. Shows the ability to adjust and be flexible to change by adapting approach when necessary. Mentors less experienced staff.
- Self-Development: Responsible for continuous self-study, trainings, partnering with more senior members of team, and/or seeking out opportunities to broaden scope to stay up to date with industry and organizational trends. Seeks feedback from senior team members for development and effectively incorporates feedback into work and behaviors.
- *Performs in accordance with system-wide competencies/behaviors.
- *Performs other duties as assigned.
Typically has 2+ years experience with modern technology and application support through education or practical experience.
- Prior experience working with healthcare claims data and using SQL to query, validate, and analyze large data sets is strongly preferred.
- Experience with SQL Server, SSRS, Power BI, advanced Excel (including formulas, PivotTables, and Power Query), and Azure DevOps or similar project tracking and reporting tools preferred.
Completes on-going training on-the-job, through courses, self-study, certifications and/or advanced degrees to maintain and enhance technical and business capabilities.
Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran