Hybrid Operations Analyst, Claims Systems & Insights

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 70,000 - 100,000; Full time

Job summary

UPMC Health Plan in the Pittsburgh area seeks an Operations Analyst, Intermediate for the Core System Operations department. This full-time hybrid role focuses on analysis of claims transactional systems and related applications.

The position requires strong analytical, communication, and project management skills, with experience in health care insurance preferred. You will lead projects, train staff, and ensure data-driven improvements across clinical and financial performance.

Qualifications

• Bachelor’s Degree or equivalent work experience.
• Minimum four 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 including Excel/Access/Word; familiarity with SQL/SSIS/Oracle advantageous.

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.
• Maintains departmental Policy and Procedure documentation; completes annual policy review updates as required.
• Participates in training programs when available/as requested.
• Assists other departments during periods of backlog.
• Manages special projects; develops/maintains project plans as needed.
• Administer, identify, test, audit, and implement new processes on transactional claims systems.
• Model business requirements for new systems and validate/fix enhancements.

Skills

Analytical abilities

Communication skills

Problem-solving

Interpersonal skills

Project management

Education

Bachelor’s degree or equivalent work experience

Tools

MS Excel

MS Access

MS Word

SQL

SSIS

Oracle

Job description

UPMC Health Plan in the Pittsburgh area seeks an Operations Analyst, Intermediate for the Core System Operations department. This full-time hybrid role focuses on analysis of claims transactional systems and related applications.

The position requires strong analytical, communication, and project management skills, with experience in health care insurance preferred. You will lead projects, train staff, and ensure data-driven improvements across clinical and financial performance.