Operations Analyst, Senior - Hybrid

UPMC; Pittsburgh, Northern (Allegheny County, KY); Hybrid; USD 85,000 - 120,000; Full time

Job summary

UPMC Health Plan is seeking an Operations Analyst, Senior in the Core System Operations department. This full-time hybrid role is based in the Pittsburgh area and focuses on the claims transactional system and related applications.

The role analyzes financial and clinical data to identify opportunities, develops solutions, and tracks progress. It requires leadership in mentoring staff and enhancing processes while coordinating with multiple departments.

Qualifications

• Experience analyzing financial and clinical data to identify opportunities.
• Ability to communicate findings to internal and external audiences.
• Proven ability to mentor and motivate staff; strong teamwork and leadership.

Responsibilities

• Maintain employee/insured confidentiality.
• Handle inquiries from data reporting and analysis.
• Participate in training programs and support analysts.
• Provide support to Operations Analysts.
• Prepare Executive Summary management documentation.
• Identify and implement work process improvements to boost team performance.
• Assist other departments during backlogs.
• Follow system-wide competencies and behaviors.
• Maintain and track the MC400 enhancement log; document specs for system enhancements.
• Manage special projects; develop and maintain project plans.
• Attend meetings on behalf of management.
• Interface with customers to answer inquiries and resolve issues.
• Manage source data dictionaries related to processes.
• Model business requirements for new systems and test fixes/enhancements.
• Participate in team meetings; contribute ideas to client satisfaction.
• Mentor and motivate staff to build a cohesive team.
• Administer, test, audit and implement new transactional claims processes.
• Meet deadlines, potentially work extended hours for project completion.
• Identify concerns impacting client satisfaction and propose data-driven solutions.
• Determine resources needed to achieve optimal outcomes.

Skills

Data analysis

Stakeholder communication

Project leadership

Process improvement

Job description

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