Quality Assurance Operational Integrity, Senior (Hybrid)- Located in Pittsburgh, PA

UPMC; Pittsburgh, Northern (Allegheny County, KY); Hybrid; USD 95,000 - 125,000; Full time

Job summary

UPMC Health Plan in Pittsburgh, PA is seeking a Senior Quality Assurance Operational Integrity professional to perform QA, risk assessments, and manage external audits. The role combines work from home and in-office duties in a hybrid arrangement.

The position emphasizes planning and executing complex audits, reporting to ISD leadership, and supporting the organization in SOC1/SSAE/SOX compliance. Mentoring and cross-functional collaboration are key components.

Responsibilities

• Conduct complex QA and risk assessments across the ISD portfolio.
• Lead external audit activity and reporting to leadership.
• Plan, execute and report on focused process audits and IT controls.
• Coordinate audits and maintain a risk-based audit plan.
• Mentor analysts and collaborate with stakeholders.

Skills

Audit competency

Root cause analysis

Data reporting

Risk management

SDLC testing

Statistical sampling

Job description

UPMC Health Plan is seeking a Quality Assurance Operational Integrity, Senior position. This is a full time position working Monday through Friday daylight hour. This is a hybrid position consisting of working from home and in office, which is located in Pittsburgh, PA.

Conduct quality assurance, operational integrity assessments and specialized reviews, and/or external audit management across the Insurance Services Divisions’ portfolio of products, services, and functional departments, supporting ISD stakeholders and leadership to mitigate risks, ensure operational integrity, audit readiness/success and compliance in the achievement of initiatives, business goals, and objectives. The QA Analyst, Senior is primarily responsible for planning, executing, and reporting on complex/specialized targeted/focused reviews and business/operational/financial/IT controls, System Configuration, System implementations, SDLC testing validation, and Data File Validation or serving as the company liaison and project lead for all external audit activity across the ISD which includes executive and Board of Director reporting and communication. The QA Analyst, Senior controls multifunctional QAOI initiatives and workgroups or external audits focusing on specialized root cause analysis, and preparing actionable data reports that provides insight and value to ISD Stakeholders.

Responsibilities

Audit Competency

• Assigned complex, highly-visible, high-risk, and critical focused process audits that have a high potential for impacts to members, providers, and UPMCHP's finances and reputation.
• Successfully demonstrates advanced competency in executing the audit process, risk management, and selecting and applying statistical methodology for population sampling.
• Utilizes source documentation to assess appropriate outcomes and integrity.
• Performs extensive root cause analysis on complex assessments and business/financial/operational/IT controls.
• Assists the QAOI Manager to ensure compliance with SOC1, SSAE, and SOX controls

Coordinator

• Assists the QAOI Manager with coordinating and assigning new audits.
• Collaborates with QAOI leadership to develop and maintain a risk-based, second line of defense audit plan.
• Serves as a peer or first reviewer of audit risk assessments, programs, workpapers, and reports.
• Exhibits a professional demeanor in protecting and building the QAOI department's brand in meetings, workgroups, and other communications.
• Mentors associate and intermediate analysts.
• Remains cognizant of industry and regulatory changes to apply to risk-based audit plan.
• Maintains working relationships with stakeholders across the ISD to remain abreast of changes that may create risks to the ISD.
• Assists in identifying process improvements within the department