COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

Search Our Jobs

   Current UPMC employees must apply in HR Direct

Quality Assurance Analyst, Associate

Description

UPMC has an exciting opportunity for a Quality Assurance Analyst, Associate position for the Health Plan.  This is a full time position working Monday through Friday flex times between 5:30 a.m. to 2:00 p.m. or 9:00 a.m. to 5:30 p.m.  This is a work from home position.

The Insurance Auditor Associate is primarily responsible for the review of high dollar claims and associated reporting.

Responsibilities:

  • Maintains employee/insured confidentiality.
  • Understands customers including internal Health Plan Departments (i.e. claims staff, customer service, Marketing, etc.) and external customers (i.e. Health System Internal Audit, Client Audit teams) and respond to customers' requests.
  • Audits high dollar claims on a prospective and/or retrospective basis.
  • Works with Reimbursement and Configuration Specialists to ensure correct payments and identify/resolve payment inaccuracies.
  • Assesses, investigates and resolves difficult issues to ensure customer satisfaction.
  • Compiles and reports statistical data to internal and external customers.
  • Participates in all training programs to develop a thorough understanding of the materials presented to the claim and service staff.
  • Leads process improvement activities, target potential problems.
  • Identifies root causes and associated error trends to determine appropriate training needs and suggest modifications to policies and procedures.
  • Devises sampling methodology and retrieves audit samples from appropriate sources.

 

Qualifications

  • High school and 4 years of claims processing, experience in physician, ancillary and/or hospital reimbursement delivery systems or insurance reimbursement, including subrogation and overpayment recovery or a Bachelor's degree required.
  • Basic understanding of managed care delivery systems.
  • Experience and knowledge of reimbursement mechanisms and clinical/procedural coding or five years of claims processing experience, including commercial and government health insurance plans and other insurance/network products.
  • Excellent analytical skills, familiarity with basic statistical analysis, and proficiency in utilizing PC based applications (i.e. Excel, MS access, COGNOS).
  • Detail-oriented individual with excellent organizational skills.
  • High level of oral and written communication skills.
  • Intermediate proficiency with Excel.
  • Intermediate proficiency with MS Office products.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

Security Alert

We are aware of scams targeting UPMC and other large companies that involve individuals posing as employees to illegitimately conduct interviews and extend false employment offers and payments to gain access to candidates' personal information. Please note that UPMC will not communicate with candidates through third-party email services like Gmail or Yahoo. While some interviews may take place via a video conferencing service, UPMC Talent Acquisition will not conduct interviews via Skype or Google Hangouts. UPMC will never ask for or disburse funds during the recruitment process. If you are hired into a role with a sign-on bonus or similar incentive, funds will be paid to you by UPMC after your start date.

If you suspect you have been a victim of a fraudulent UPMC job offer, please report the attempt using this form.