Operations Analyst, Associate- Hybrid- Pittsburgh, PA
Job ID: 6474899711
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: Exchange Operations
Location: 600 Grant St, Pittsburgh, PA
Union Position: No
Salary Range: $ 23.94-41.33 USD
UPMC Health Plan has an exciting opportunity for a Operations Analyst, Associate position in the Exchange Operations department. This is a full time position working Monday through Friday daylight hours and is a hybrid shift working 3 days in office and 2 days at home. This position is located in the US Steel Tower.
Oversees administrative, system processes and special projects as they relate to the identification, implementation and maintenance of the claims transactional system for all UPMC Health Plan products. Under the general direction of Business Support Management, this role will analyze, identify, propose and implement solutions for all business areas. Acts as subject matter expert supporting all areas, and interact with staff to answer questions and resolve issues as they arise.
Responsibilities:
- Identify areas of concern that may compromise client satisfaction through data analysis, and propose solutions based on findings, expertise, and research
- Model business requirements for new systems, special projects and enhancements to existing systems; validate and test fixes/enhancements to new and existing systems
- Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork
- Completes Executive Summary management documentation as required
- Performs in accordance with system-wide competencies/behaviors
- Participates in training programs when available/as requested
- Effectively prioritize and complete all assigned tasks
- Identify, administer, test, audit, and implement new processes on transactional claims systems
- Interface with customers by telephone, correspondence, and or in person to answer inquiries and resolve concerns/issues
- Performs other duties as assigned
- Assists other departments during periods of backlogs
- Manages, updates, and maintains source data dictionaries as they relate to processes
- Completes inquiries generated from the data reporting and analysis area
- Maintains employee/insured confidentiality
Qualifications:
- Bachelor’s Degree or equivalent work experience.
- Minimum two years general business experience.
- Experience in health care insurance or health care industry preferred, but those with relevant experience in other industries will be considered Knowledge of Commercial, Medicaid, Medicare and Individual products preferred.
- Competence in MS Office required, including MSExcel, MSAccess, MSWord.
- Excellent planning communication, documentation, analytical and problem solving abilities.
- Ability to work in a fast-paced environment.
- Must possess strong interpersonal, organizational, and project management skills, with the ability to work on multiple tasks simultaneously.
- Experience in QA/Audit/Systems testing development and execution preferred.
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
Born in Syria, Jouli H. had a childhood dream of becoming a nurse. After moving to the United States and initially pursuing a different career, Jouli decided to return to school when she turned 30, returning to the hope and dream she had as a little girl. After attending UPMC Mercy School of Nursing, Jouli has continued her UPMC career journey, even becoming a mother along the way.
Jouli’s Career Journey:
⦁ 2020: Staff Nurse – UPMC Mercy
⦁ 2020: Professional Staff Nurse – UPMC Mercy
⦁ 2021: Professional Staff Nurse, BSN – UPMC Mercy
⦁ 2022: Professional Staff Nurse, BSN, Casual – UPMC Mercy
⦁ 2023: Sr. Professional Staff Nurse, BSN, Casual – UPMC Mercy
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 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 engagement & inclusion
- 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 engagement & inclusion
- 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 Engagement & Inclusion
- 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
Through tuition assistance and mentorship by coworkers, Keshon launched his nursing career in his hometown of McKeesport.
Since growing up in Syria, Jouli H.’s story has been one that inspires all of us to remember how empowerment can truly change someone’s life.
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!
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!
