Job Description

Job Title: TPA Performance Manager
Job ID: 724635
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: TPA Claims_Ops
Location: 600 Grant St, Pittsburgh PA 15219

Description

Are you ready to be empowered to make a difference? If so, the TPA Performance Manager position is the fit for you! Join our consistently high performing team. This position will oversee and manage a dynamic team of TPA professionals responsible for supporting TPA Operations. This includes managing projects, supporting analysis, issue resolution, and managing activities related to TPA objectives, goals, and initiatives impacting service level agreements and client satisfaction. Data Analytics based on Six Sigma and/or other proven methodologies.

Responsibilities:
  • Apply cross functional change management and implementation strategies, ensure that all of the team members and other participating parties have committed to effective implementation of process and procedures (including staff, vendors, clients, etc.)
  • Assist team members in resolving assignment and project problems; escalate issues when necessary and facilitate decision making.
  • Ensure quality of results via data analytics; information business case builds, and process/application level testing; including test validation per business needs.
  • Ensure team and individual projects and assignments are completed efficiently - on time and within budget.
  • Ensure team provides service and support according to the expectations of service level agreements; corporate/project deadlines; compliance and regulatory requirements.
  • Maintain policies and procedures of the team/department.
  • Maintains a positive work environment for staff members. Build a cohesive, professional, and self-directed team environment.
  • Perform cost benefits analysis.
  • Provide leadership and direction for the team through developing and updating procedures, programs, staffing requirements and training opportunities.
  • Responsible to recruit, develop, and motivate a high caliber staff to support departmental and organizational objectives.
  • Review and prioritize staff assignments to ensure efficient operations based on workload. Assigns and delegates responsibility for specific work or functional activities.

Qualifications

  • Bachelors degree preferred in related field. 
  • 5 years health insurance product knowledge with strong business acumen. 
  • Well informed and conversant with general business, economic, and clinical matters. 
  • Ability to lead, mentor, coach, and develop professional staff in an environment dealing with a high level of ambiguity. 
  • Demonstrated leadership skills, with ability to facilitate completion of team/staff tasks, projects, or assignments on time and within budget. 
  • Ability to analyze financial and clinical results to comprehend forecasting models.  
  • Ability to make decisions or recommendations based on various types and amounts of information. 
  • Excellent computer skills with proficiency in MS Access, Excel, or financial software packages and reporting tools. 
  • SQL experience highly preferred. 
  • Demonstrate a high degree of interpersonal skills and professionalism to forge positive working relationships within the department, with other departments, and with external audiences. 
  • Excellent project management skills with familiarity of Six Sigma, Agile management or applicable methodologies highly preferred.  
  • Must possess excellent analytical, troubleshooting, and problem-solving skills; sense of urgency, responsiveness and judgement to make effective decisions is required. 
  • Third Party Administrator experience a plus.
  • Previous claims experience highly preferred. 


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

Salary Range: $30.89 to $52.76

Union Position: No

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