At UPMC, we are committed to keeping our communities safe and healthy as the COVID-19 pandemic continues to evolve. As our recruiters work to fill positions during this time, interviews and recruitment-related processes have been modified to protect and prioritize the safety of our candidates and employees.

UPMC continues to comply with any governmental guidance related to local, state, and federal COVID-19 vaccination and testing requirements where our team members live and work. UPMC strongly supports vaccination and encourages everyone who can get vaccinated to do so to protect themselves, their co-workers, and our patients. At this time, the COVID-19 vaccination is available for new or existing employees on a voluntary basis, except where required by local, state, or federal authorities. Staff in positions in our New York, Maryland, and City of Philadelphia areas must be in compliance with local COVID-19 mandates.

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

Operations Excellence Analyst Associate

  • Job ID: 274999805
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Operations Support
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $24.05 to $41.60 / hour

Description

At UPMC, we’re all here for the same reason – to make Life Changing Medicine happen. Join our team and you will play a unique and important role in our mission to change healthcare for the better.

UPMC Health Plan is hiring a full-time Operations Excellence Analyst Associate to support our Operations Support department. This will have a Monday through Friday daylight schedule. This is a remote/work-from-home position with the potential for training and orientation to be held on-site in Pittsburgh, PA.

Under the leadership of the Manager of Claims, the Operations Excellence Analyst Associate will provide support and analytics for all factors impacting UPMC and clients. This role will manage projects and initiatives, as well as easy to intermediate specification extractions of claims and performance data for reports, trends and analysis for UPMC Commercial clients.

Experience working with Microsoft Excel / SQL queries and inventory management is preferred.


Responsibilities:

  • Review insurance contracts to determine whether the Company's risks are assumed by the contract and evaluate the coverage opinions to determine agreement or disagreement with the insurance company's evaluation of coverage for claims
  • Assist and advise claims adjusters and corporate personnel on Risk Management interpretation of various claims.
  • Coordinate the evaluation, direction and management of claims - corresponding directly with departments throughout the Company and the Company's insurance carriers, brokers and TPAs - with an aim to minimize losses. This will include: Supervising the investigation of claims and suits by coordinating and consulting with insurance adjusters, insurance company's attorneys, corporate counsel, and outside counsel hired by the insurance company.Participating in mediations, arbitrations and trials involving claims made against the Company and/or insurance carrier.Advising in the denial or acceptance of all claims made against the Company. Advise the claims adjusters on cross liability issues, and other claim management issues.
  • Prepare monthly and quarterly status reports, as well as ad hoc loss runs and other claim data analyses from the TPA's system, company information and other sources.
  • Supports Management in department-related research and projects as requested.

Qualifications

  • Bachelor's Degree and/or equivalent education or work experience
  • 4 years operations health insurance and/or customer service experience required.
  • Strong analytical skills
  • Skilled in reading and writing moderate to complex SQL commands and accurately assessing results (preferable 3+ years)
  • Working knowledge of relational databases, database structures
  • Ability to operate independently: exhibiting independent decision making in a fast paced environment dealing with a high level of ambiguity.
  • Strong time management skills.
  • Excellent documentation, organization, interpersonal, and written communication skills.
  • A professional demeanor with the ability to manage multiple priorities and meet deadlines required.
  • Competent in Microsoft Office; Excel, Word, Visio, PowerPoint
  • Ability to learn SharePoint Designer Software within the first 6 months
  • Ability to learn basic report generation/claim data extraction within the first 6 months
  • Third Party Administrator experience a plus


Licensure, Certifications, and Clearances:

  • Act 34


    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