Job Description

Job Title: Operations Analyst, Intermidiate Claims Compliance
Job ID: 746233
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: Operations
Location: 600 Grant St, Pittsburgh PA 15219


Do you have a strong background in health insurance claims  If so, an opportunity as an Operations Analyst, Intermediate with UPMC Health Plan's Claims Operations team may be the perfect fit for you. This position oversees administrative, system processes and special project as they relate to identification, implementation and maintenance of the claims transactional system and other applications for all UPMC Health Plan products. Under the general direction of the Claims Operations team, this role will analyze, identify, propose and implement solutions for all business areas.  The Operations Analyst, Intermediate must use their knowledge and understanding of financial, clinical and other information generated by numerous sources to identify opportunities to improve clinical and financial performance. Furthermore, the position requires the ability to articulate these opportunities to internal and external audiences, implement the solutions, and track and monitor progress.  These functions must be done while also weighing the practical considerations and potential barriers that need to be overcome to successfully implement new programs and processes. 

  • Administer, identify, test, audit, and implement new processes on transactional claims systems
  • Allocates the Operations Analysts time appropriately to meet production and quality standards
  • Assists other departments during periods of backlogs
  • Attends meetings on behalf of Management team
  • Completes Executive Summary management documentation as required
  • Completes inquiries generated from the data reporting and analysis area
  • Effectively prioritize and complete all assigned tasks
  • Identify areas of concern that may compromise client satisfaction through data analysis, and propose solutions based on findings, expertise, and research
  • Interface with customers by telephone, correspondence, and or in person to answer inquiries and resolve concerns/issues
  • Maintains departmental Policy and Procedure documentation; completes annual policy review making necessary updates as required
  • Maintains employee/insured confidentiality
  • Manages special projects as assigned by Management team; develops/maintains project plans, as needed
  • Manages, updates, and maintains source data dictionaries as they relate to processes
  • 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
  • Participates in training programs when available/as requested
  • Performs in accordance with system-wide competencies/behaviors
  • Performs other duties as assigned
  • Provides support to Operations Analysts
  • Trains new and existing employees on departmental policies and procedures


  • Bachelor's Degree or equivalent work experience. 
  • Minimum four 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 Microsoft Office required, including Excel, Access, Word.
  • Competence of the most common features of specialized analysis and reporting tools, e.g. SQL, SSIS, Oracle, and MS Office Suite.
  • 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.

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

Salary Range: $22.60 to $39.11 / hour

Union Position: No

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