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   Current UPMC employees must apply in HR Direct

Business Analyst

Description

UPMC Health Plan has an exciting opportunity for a Business Analyst in its National Network Management department, located in downtown Pittsburgh at the U.S. Steel Tower.

The Business Analyst will support and coordinate inquiries, responses, and reporting related to the Vendor Relations team's activities. The successful candidate will work with both internal and external customers to identify and resolve issues in a timely fashion. This role will maintain project planning documents, prepare materials, write and distribute workflow, and maintain the UPMC Health Plan Systems Portfolio.


Responsibilities:

  • Effectively prioritize and complete all assigned tasks.
  • Maintain employee/insured confidentiality.
  • Ability to analyze benefit administration issues to determine the need for and the scope of policies and procedures.
  • Develop administration policies and procedures or business recommendations to ensure uniform, cost-effective claims administration practices that comply with the law, plan documents, and other company policies.
  • Participate in training programs as available/requested.
  • Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork.
  • Assist other departments during periods of backlogs.
  • Ensures that vendors are contracted in accordance with UPMC Health Plan (UPMCHP) policies and procedures. 
  • Manages vendor contracts so that both the vendor and UPMC Health Plan adhere to all contractual responsibilities. 
  • Prepares reports on vendor and provider agreements for Health Plan oversight purposes, state filings and regulatory agency oversight.  
  • Coordinates distribution of data from vendors to other UPMC Health Plan departments.  Also acts as a liaison between vendors and UPMC Health Plan staff.
  • Develops and updates department policies and procedures to ensure proper process flows as well as compliance, as applicable, with governmental and regulatory regulations.
  • Assists Manager and Director in meeting established goals as outlined in the UPMC Health Plans business plans.
  • Performs in accordance with system-wide competencies/behaviors.
  • Performs other duties as assigned.

Qualifications

  • Bachelor's degree or equivalent related work experience required.
  • Minimum of two years of general business experience required.
  • Minimum of two years of experience in business/industry specialty required.
  • Knowledge of commercial, Medicaid, and Medicare products preferred.
  • Competent in MS Office and PC skills preferred.
  • Working knowledge of COB (Coordination of Benefits) preferred.
  • Organizational, interpersonal, and communication skills required.


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