QAOI, Intermediate (Hybrid)- Pittsburgh, PA

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 65,000 - 90,000; Full time

Job summary

UPMC Health Plan is seeking a Quality Assurance Operational Integrity professional for a full-time hybrid role. The QAOI, Intermediate will plan, execute, and report on focused reviews across ISD, supporting leadership to mitigate risks and ensure compliance with initiatives and objectives.

The incumbent leads small QA initiatives, performs root cause analysis, and prepares actionable data reports for stakeholders, while maintaining independence and applying best practices across the

Qualifications

• Experience planning, executing, and reporting on QA activities.
• Ability to conduct root cause analyses and synthesize findings.
• Strong collaboration with ISD stakeholders and leadership.

Responsibilities

• Exhibits professionalism and supports process improvements within the department.
• Execute the audit process, risk management framework, and sampling methods.
• Meet departmental standards for quality and operational integrity.
• Complete assignments accurately, timely, and with proper documentation.
• Engage with partners and SMEs across ISD and maintain certifications as appropriate.
• Serve as a stakeholder QAOI consultant and prepare actional data reports.
• Define scope, plan reviews, coordinate meetings, and ensure completion.
• Prepare finding reports/workpapers with clear spelling and organization.
• Track and follow up on past work and lead small initiatives.

Skills

Quality Assurance

Operational Integrity

Root Cause Analysis

Stakeholder Management

Auditing

Job description

UPMC Health Plan has an exciting opportunity for a Quality Assurance Operational Integrity position. This is a full-time position working Monday through Friday daylight hours. This is a hybrid position with requirements and expectations to be discussed during the interview process.

The QAOI, Intermediate will conduct quality assurance and operational integrity assessments and reviews across the Insurance Services Divisions’ portfolio of products, services, and functional departments, supporting ISD stakeholders and leadership to mitigate risks, ensure operational integrity, and compliance in the achievement of initiatives, business goals, and objectives. The QAOI, Intermediate is primarily responsible for planning, executing, and reporting on assigned annual focused reviews and business/operational/financial controls across the ISD, as determined by leadership, and reported to the Executive Leadership and Board of Directors. Additionally, the incumbent may lead small scale QA initiatives, projects, and workgroups including conducting root cause analyst and preparing actional data reports that provides insight and value to ISD Stakeholders.

Responsibilities

• Exhibits professionalism in protecting and building the department’s brand. This includes contributing to a positive QAOI work community modeling department tenets, as well assisting in identifying opportunities for process improvements within the department.
• Successfully demonstrate competency in executing the audit process, risk management framework, selecting and applying appropriate statistical methodology for population sampling and confidence levels.
• Meets departmental standards for quality and internal operational integrity.
• Demonstrates accurate, thoroughly, and timely completion of assignments.
• Has built a solid internal network of partners and SMEs across the ISD, as well as maintains specialized certification and keeps up with industry and specialized best practices and protocols as appropriate.
• Can serve as a stakeholder QAOI consultant.
• Readily identifies and uses source documents to assess appropriate outcomes, integrity, and root cause on assigned targeted reviews, and business/financial/operational/IT controls.
• Defines scope, verify requirements/deliverables for review activity including planning coordinating, participating in meetings, and following through to assignment completion (including mock audits).
• Prepares accurate and thorough finding reports/workpapers with consistent correct spelling, grammar, and organization.
• Tracks and performs follow-up for past work.
• Leads small scale initiatives, workgroups, mock audits.
• Successfully interacts and establishes credibility with stakeholders including maintaining independence and selecting the appropriate meeting formats.
• Understands the organization structure and how applies to work, as well as ISD initiatives that may impact work.
• Performs other duties as assigned and performs in accordance with system-wide competencies/behaviors.