Job Description

Job Title: TPA Performance Analyst-Senior
Job ID: 712328
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Community HealthChoices
Location: 600 Grant St, Pittsburgh PA 15219

Description

Support TPA professional and leadership staff in the strive for operational excellence by taking a lead role and serving as process expert for more complex and sensitive opportunities and challenges. The incumbent relies on advanced technical, analytical, and reporting skills to recommend and implement solution and/or processes to support TPA operational excellence. Serves as a lead for specified project/initiative tasks, in addition to mentoring less experienced staff. Complex problem solving, broader scope of responsibility; excellent technical knowledge/skills, and analytical abilities, decision making.

Responsibilities:
  • Act as a mentor to less experienced/skilled TPA Operation Analyst.
  • Aligned assigned responsibilities with TPA clients performance expectations and department goals and objectives.
  • Attends senior level meetings representing TPA Operation. This includes leading client tours and claim demonstrations.
  • Develop complex clinical/financial/medical claim data extracts and reporting, including refining relevant information.
  • Effectively represent TPA Claim Operations and Provider Services interests. Assess pros and cons of operational process decisions and impacts to resources, processes, and outcomes.
  • Implement effective monitoring and ongoing measurement for solutions/issue resolution.
  • Interpret clinical/financial/medical claim data and events for Senior Management who must make operational business decisions.
  • Investigate variances and derive solutions to variant outcomes, results, and quality issues.
  • Keep abreast of all pertinent guidelines, products, regulatory, compliance, policies and procedures.
  • Keep abreast of pertinent technology updates such as SharePoint Designer and SQL to effectively perform job.
  • Perform basic duties of the TPA Performance Analyst-Interm position as needed.
  • Perform cost/benefits analysis.
  • Represent and/or lead Operational re-engineering or process improvement.
  • Serve as TPA claims process, knowledge, and reporting consultant.
  • Serve as a positive extension of the TPA leadership team.

Qualifications

  • Bachelors Degree in related field or equivalent work experience
  • 4 years health insurance experience.
  • Medical claims processing/adjustment experience highly preferred.
  • 2 years Financial and/or medical analysis experience
  • Demonstrated leadership skills and abilities; strong independent decision making ability required.
  • Must possess excellent analytical, troubleshooting, and problem-solving skills.
  • Excellent documentation, organization, interpersonal, and written communication skills.
  • High level of professionalism with the ability to forge positive working relationships.
  • Excellent PC skills. Proficient using Microsoft Excel, Viso, PowerPoint, Word, Access Meet deadlines and manage multiple priorities in an ambiguous work environment.
  • Ability to run intermediate to advanced reports using SQL, Access, or reporting tools for trending and analysis
  • Third Party Administrator experience a plus

    Licensure, Certifications, and Clearances:
    UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $26.64 to $44.88

Union Position: No

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