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Job Description

Job Title: Operations Analyst, Lead
Job ID: 896665067
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: Medicare Compliance
Location: 600 Grant St, Pittsburgh PA 15219


UPMC Health Plan's Medicare Compliance department is seeking an Operations Analyst, Lead!

This department works to confirm compliance and regulations are followed by the Operational departments. Oversees administrative and system processes as they relate to implementation and maintenance of the claims transactional system in additional to other applications for all UPMC Health Plan products. Under the general direction of the Business Support Management team, 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. The Operations Analyst, Lead 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. Will take a leadership role in the enhancement, development, documentation, and communication of identified variances. 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. To successfully perform the role, must understand the causes of financial & clinical trends and anomalies.

  • Takes a leadership role in mentoring and motivating staff building a strong cohesive team
  • Serve as a role model by providing quality services that are responsive to client needs and proactive in scope. Respond to the needs of individual employees, departments, or other organizations with courtesy, respect, and a positive outlook that reflects the team effort of the department.
  • Meets deadlines and turnaround times set by Management staff which may, at times, require an employee to work extended hours until completion of project
  • Attends meetings on behalf of Management team
  • Performs in accordance with system-wide competencies/behaviors
  • Identify, administer, test, audit and implement new processes, on transactional claims systems
  • Participates in training programs when available/as requested
  • Model business requirements for new systems, special projects and enhancements to existing systems; validate and test fixes/enhancements to new and existing systems
  • Performs other duties as assigned
  • Maintain employee/insured confidentiality
  • Identify areas of concern that may compromise client satisfaction through data analysis, and propose solutions based on findings, expertise, and research
  • Provides support and supervision to Operations Analysts
  • Interface with customers by telephone, correspondence, and or in person to answer inquiries and resolve concerns/issues
  • Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork
  • Identify appropriate resources and support needed to facilitate decisions to achieve optimal outcomes
  • Manages special projects as assigned by Management team; develops/maintains project plans, as needed
  • Completes Executive Summary management documentation as required
  • Allocates Operations Analysts time appropriately to meet production and quality standards
  • Manages, updates, and maintains source data dictionaries as they relate to processes
  • Assists other departments during periods of backlogs
  • Actively identifies and implements work process improvements to enhance team performance
  • Maintains and updates MC400 enhancement log and tracking form; documents specifications for system enhancements on appropriate forms retaining data on department share drive; ensures all activities are appropriately monitored and resolved timely
  • Prepares employee performance reviews and conducts employee action plans.
  • Completes inquiries generated from the data reporting and analysis area


  • Bachelor's Degree or equivalent work experience
  • Minimum five years general business experience
  • Access and database abilities 
  • 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

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $27.98 to $47.14 / hour

Union Position: No

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