UPMC Health Plan has an exciting opportunity for an Operations Analyst, Senior 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 projects as they relate to 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, 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, Senior 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:
- Maintain employee/insured confidentiality
- Performs other duties as assigned
- Completes inquiries generated from the data reporting and analysis area
- Participates in training programs when available/as requested
- Provides support to Operations Analysts
- Completes Executive Summary management documentation as required
- Actively identifies and implements work process improvements to enhance team performance
- Assists other departments during periods of backlogs
- Performs in accordance with system-wide competencies/behaviors
- Maintains and updates MC400 enhancement log and tracking form; documents specifications for system enhancements on appropriate forms retaining data on department share drive; ensures all activities are appropriately monitored and resolved timely
- Manages special projects as assigned by Management team; develops/maintains project plans, as needed
- Attends meetings on behalf of Manager/Director
- Interface with customers by telephone, correspondence, and or in person to answer inquiries and resolve concerns/issues
- Manages, updates, and maintains 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
- Takes a leadership role in mentoring and motivating staff building a strong cohesive team
- Administer, identify, test, audit and implement new processes on transactional claims systems
- Meets deadlines and turnaround times set by Management staff which may, at times, require an employee to work extended hours until completion of project
- 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
- Bachelor's Degree or equivalent work experience.
- Minimum five 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.
- 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