Quality Assurance Operational Integrity, Senior (hybrid)

UPMC Health Plan is hiring a Quality Assurance Operational Integrity, Senior for their Operational Risk Integrity Department. This is a hybrid role, Work from home opportunities are available with this role. At times, you may be asked to travel to the office for business needs. 

In this role you will 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. In this role you will support ISD stakeholders and leadership to mitigate risks, ensure operational integrity, audit readiness/success and compliance in the achievement of initiatives, business goals, and objectives. You would be 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. In this role, you would control 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:

• 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.
•  Mentors Associate and Intermediate professionals as requested.
• Successfully demonstrates advanced knowledge executing the audit process, risk management framework, selecting and applying appropriate statistical methodology for population sampling and confidence levels.
•  Serves as a role model executing departmental standards for quality and internal operational integrity.
• Exhibits strong project management skills while demonstrating accurate, thoroughly, and timely completion of assignments.
• Leverages a strong 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. Serves as a stakeholder & business QAOI consultant.
• Readily identifies and uses source documents to assess appropriate outcomes, integrity, and root cause on assigned complex assessments, 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 functional or specialized QAOI initiatives, workgroups, mock audits.
• Successfully interacts and establishes credibility with high level professionals and mid-level leadership including maintaining independence and selecting the appropriate meeting formats.
•  Understands the organization structure and how applies to work, as well as keeps pulse on ISD initiatives that may QAOI.
• Performs other duties as assigned and performs in accordance with system-wide competencies/behaviors.