Claims Operations Assurance Analyst, Associate
Job ID: 7476447484
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Work Arrangement: Hybrid
Facility: UPMC Health Plan
Department: Operations Support
Location: 600 Grant St, Pittsburgh, PA
Union Position: No
Salary Range: $ 27.89-48.21 USD
We’re looking for a Claims Operational Assurance Associate—someone who loves digging into details, spotting trends, and making processes better. In this role, you’ll be part of a team that ensures our Claims Operations run smoothly, stay compliant, and continuously improve. Think of yourself as the detective and strategist rolled into one: you’ll research, investigate, audit, and provide insights that help shape the future of our claims organization.
You’ll monitor processes, identify risks, and recommend solutions that keep us compliant and efficient. Plus, you’ll manage projects, analyze data, and deliver actionable insights that make a real impact.
This is a hybrid position with an in-office requirement of once a month.
What You’ll Be Doing:
- Prioritize and complete tasks with accuracy and quality—your attention to detail matters.
- Work closely with internal teams and stakeholders to identify problems and propose smart solutions.
- Use data to uncover trends, root causes, and areas for improvement—then turn those findings into action.
- Monitor errors and issues that affect client satisfaction and recommend fixes to improve processes and tools.
- Stay up-to-date on guidelines, regulations, and best practices.
- Manage projects and initiatives that drive quality and compliance.
- Analyze performance against benchmarks and help build new processes that raise the bar.
- Explain your findings clearly to both technical and non-technical audiences, including leadership.
- Collaborate with experts across Clinical Operations, Pharmacy, Member Services, Sales, Marketing, and more to align strategies and improve outcomes.
- Review claims for accuracy and assist with risk management interpretations.
- Support management with research and special projects.
Why This Role Matters: Your work will directly influence how we deliver quality service to our members and partners. If you enjoy problem-solving, working with data, and making processes better, this role gives you the chance to do all that—and more—while collaborating with a team that values innovation and continuous improvement.
Qualifications:
- Bachelor’s Degree and/or equivalent education or work experience.
- 4 years operations health insurance and/or customer service experience required.
- Knowledge of Healthcare claims processing and/or claims processing experience strongly preferred.
- Strong analytical skills.
- Working knowledge of relational databases, database structures.
- Ability to operate independently: exhibiting independent decision making in a fast-paced environment dealing with a high level of ambiguity.
- Strong time management skills. Excellent documentation, organization, interpersonal, and written communication skills.
- A professional demeanor with the ability to manage multiple priorities and meet deadlines required.
- Competent in Microsoft Office; Excel, Word, Visio, PowerPoint.
- Ability to learn basic report generation/claim data extraction within the first 6 months.
Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran
CAREER GROWTH
Grow Your Nursing Career
Spanning over 20 clinical specialties and more than 50 unique nursing roles, every nurse at UPMC can achieve and advance their goals with the My Nursing Career Ladder. Whether you’re looking to progress to an elevated role or continue your education, UPMC equips nurses with the resources, feedback, leadership, and benefits to help you succeed and achieve your career goals. Here’s how a few nurses have grown their careers through the years at UPMC:
Clyde C.
As a Professional Staff Nurse, Expert at UPMC Muncy, Clyde is a great example of someone who has taken advantage of UPMC’s My Nursing Career Ladder to grow his career while remaining in the same hospital location.
Clyde’s Career Journey:
⦁ 2017: Professional Staff Nurse – UPMC Muncy
⦁ 2021: Sr. Professional Staff Nurse – UPMC Muncy
⦁ 2022: Sr. Professional Staff Nurse II – UPMC Muncy
⦁ 2022-present: Professional Staff Nurse, Expert – UPMC Muncy
Michelle B.
In her current role as a Professional Staff Nurse, Expert at UPMC Presbyterian, Michelle cares for patients with chronic and ongoing health issues as part of a Medical-Surgical unit. Michelle enjoys the daily change that Med-Surg nursing brings, and has found a career path that is interesting, meaningful, and full of opportunity.
Michelle’s Career Journey:
⦁ 2019: Staff Nurse – UPMC Presbyterian
⦁ 2020: Professional Staff Nurse – UPMC Presbyterian
⦁ 2021: Professional Staff Nurse, BSN – UPMC Presbyterian
⦁ 2021: Sr. Professional Staff Nurse, BSN – UPMC Presbyterian
⦁ 2022: Sr. Professional Staff Nurse II, BSN – UPMC Presbyterian
⦁ 2023: Professional Staff Nurse, BSN, Expert – UPMC Presbyterian
INSURANCE SERVICES DIVISION OF UPMC
Advance Your Future
A career with UPMC means more than just caring for patients – when you’re a part of UPMC Insurance Services Division, it means caring for more than four million insurance members, too. UPMC Insurance Services Division offers a full range of health insurance products and services to our network across the country, providing peace of mind, better health, and financial security to our members, along with limitless career opportunities and a rewarding mission to those on our team.
About UPMC Insurance Services Division
As an integrated health care provider-insurer, UPMC goes beyond patient care to provide insurance products and services to millions of members. Our team partners with UPMC and community network providers to deliver knowledge and expertise that provides the highest quality care at the most affordable price, supporting our members through service, communication, and more.
Fast Facts:
- We provide insurance products and services to over more than four million members.
- UPMC’s Insurance Services Division offers a full range of health insurance options including UPMC Health Plan, Workpartners, UPMC for Life, UPMC for You, UPMC for Kids, UPMC Community HealthChoices, and Community Care Behavioral Health.
- UPMC Health Plan is among the nation’s fastest-growing health plans.
Opportunities on Our Team
We’ve got a job that’s just right for you! UPMC Insurance Services Division team offers a vast array of career paths and opportunities, from career areas like customer service, data analytics, and information technology and even patient care roles like social work, nursing, and care management.
Whether in non-clinical or patient-facing roles, our team impacts patients and members by providing quality experiences before, during, and after their care, building relationships in a unique and meaningful way.
Recognized for Excellence
Be a part of an award-winning team! UPMC Insurance Services Division has been recognized for outstanding care and service with awards that include:
- U.S. News and World Report named UPMC for Life a “Best Insurance Company for Medicare Advantage” in Pennsylvania for 2024.
- The Human Rights Campaign Foundation has named UPMC Health Plan an “Equality 100 Leader in LGBTQ+ Workplace Inclusion” for 2023–2024.
- UPMC for Life ranked #1 in Customer Satisfaction* among Medicare Advantage Plans in Pennsylvania by J.D. Power.
- The Ethisphere Institute named UPMC as one of the World’s Most Ethical Companies for the sixth consecutive year.
*Results are based on award-eligible plans in Pennsylvania by J.D. Power. For J.D. Power 2024 award information visit, jdpower.com/awards.
Jump-Start Your Career
Looking to launch a career with longevity and opportunity? With countless entry-level opportunities for recent graduates, along with tools and resources that empower you as you learn and grow, UPMC Insurance Services Division is the perfect place to get a career started.
Interested in taking your career to new heights? Our career paths and advancement opportunities will provide you with chances to achieve your goals at every step.
BENEFITS AND LIFE AT UPMC
We know that you have many options when choosing where to build your career. So why choose UPMC? We can think of a few reasons.
Work-Life Balance
Finding the ideal balance to manage the important elements in your life.
Development & Opportunities
Enhancing your career through continued learning opportunities and/or advancement.
Compensation
Receiving competitive pay for the work that you do – base pay, merit, and premium pay.
Performance & Recognition
Rewarding performance that supports the goals and mission of UPMC.
Benefits
Providing assistance and security to meet the current and future needs of you and your family.
Work-Life Balance
Finding the ideal balance to manage the important elements in your life.
Development & Opportunities
Enhancing your career through continued learning opportunities and/or advancement.
Compensation
Receiving competitive pay for the work that you do – base pay, merit, and premium pay.
Performance & Recognition
Rewarding performance that supports the goals and mission of UPMC.
Benefits
Providing assistance and security to meet the current and future needs of you and your family.
Benefits that Matter to You
We’re committed to providing benefits that meet your needs and support your well-being in all areas of life.
- Earn over 5 weeks of paid time off every year
- Affordable medical, dental & vision coverage
- Student loan assistance and tuition reimbursement options
- Earn up to 8% of your eligible pay in retirement contributions from UPMC
- Employer-paid life insurance
Benefits that Matter to You
We’re committed to providing benefits that meet your needs and support your well-being in all areas of life.
- Earn over 5 weeks of paid time off every year
- Affordable medical, dental & vision coverage
- Student loan assistance and tuition reimbursement options
- Earn up to 8% of your eligible pay in retirement contributions from UPMC
- Employer-paid life insurance
Benefits that Matter to You
We’re committed to providing our employees with benefits that meet their needs and support their well-being in all areas of life.
- Earn over 5 weeks of paid time off every year
- Affordable medical, dental & vision coverage
- Student loan assistance and tuition reimbursement options
- Earn up to 8% of your eligible pay in retirement contributions from UPMC
- Employer-paid life insurance
Support for You – and Your Family
Your career doesn’t impact just you, but the people you care about, too. We’re making sure your career works for the whole family.
- Two weeks of paid parental leave
- Family planning resources
- Tuition assistance for dependents
- Comprehensive health care for dependents
- Emergency child and elder care options
- Flexible work arrangements
Support for You – and Your Family
Your career doesn’t impact just you, but the people you care about, too. We’re making sure your career works for the whole family.
- Two weeks of paid parental leave
- Family planning resources
- Tuition assistance for dependents
- Comprehensive health care for dependents
- Emergency child and elder care options
- Flexible work arrangements
Support for You – and Your Family
Your career doesn’t impact just you, but the people you care about, too. We’re making sure your career works for the whole family.
- Flexibility to choose the shifts and work arrangements that work best for your lifestyle
- Two weeks of paid parental leave
- Family planning resources
- Comprehensive health care for dependents
- Emergency child and elder care options
A Culture That Cares
At UPMC, you can find a home among people who share your passions and care about who you are.
- Employee resource groups
- Awards for champions of dignity & respect
- Center for Workplace Culture and Engagement
- Programs for veteran engagement
A Culture That Cares
At UPMC, you can find a home among people who share your passions and care about who you are.
- Employee resource groups
- Awards for champions of dignity & respect
- Center for Workplace Culture and Engagement
- Programs for veteran engagement
A Culture That Cares
UPMC is a place where you can find a home, no matter your gender, race, sexual orientation, age, or culture, and where you can meet people who share your passions and care about you.
- Employee resource groups
- Awards for champions of dignity & respect
- Center for Workplace Culture and Engagement
- Programs for Veteran Engagement
Tools to Reach Your Potential
Once you become a member of our team, the journey doesn’t stop there. UPMC is committed to supporting your growth and helping you build the career of your dreams.
- Up to $6,000 of annual tuition assistance
- Ongoing learning via LinkedIn Learning
- Accelerated career pathways for growth
- Robust instructor-led education and learning pathways
Tools to Reach Your Potential
Once you become a member of our team, the journey doesn’t stop there. UPMC is committed to supporting your growth and helping you build the career of your dreams.
- Up to $6,000 of annual tuition assistance
- Ongoing learning via LinkedIn Learning
- Accelerated career pathways for growth
- Robust instructor-led education and learning pathways
Tools to Reach Your Potential
Once you become a member of our team, the journey doesn’t stop there. UPMC is committed to supporting your growth and helping you build the career of your dreams.
- Unlimited educational possibilities, including no-cost BSN and MSN programs
- Robust career ladders for every nurse – no matter your specialty, location, or career stage
- Up to $6,000 of annual tuition assistance
- Ongoing learning opportunities
Expansive Opportunity
Where do you want to go with your career? Wherever it is, UPMC can take you there.
- 100,000 employees
- 40+ hospitals and 800+ doctors’ offices and outpatient sites
- Dozens of career ladders to climb
- International locations
- State-of-the-art technology
Expansive Opportunity
Where do you want to go with your career? Wherever it is, UPMC can take you there.
- 100,000 employees
- 40+ hospitals and 800+ doctors’ offices and outpatient sites
- Dozens of career ladders to climb
- International locations
- State-of-the-art technology
Expansive Opportunity
Where do you want to go with your career? Wherever it is, UPMC can take you there.
- 100,000 employees
- 40+ hospitals and 800+ doctors’ offices and outpatient sites
- International locations
- State of-the-art technology
Read More about Nursing at UPMC
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Starting her career in Environmental Services, Leah shares how she fell in love with health care and became a nurse.
Read More about UPMC Insurance Services Division
In UPMC Insurance Services Division, analysts work to understand, innovate, and improve the products and services UPMC provides.
Eddie S. shares how his passion for football, fishing, and friendship shapes his life and his career with UPMC Health Plan.
We asked our nurses to shed some light on what Med-Surg nursing means to them. Get to know Med-Surg nursing – in four words – from UPMC nurses!
