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Workers Compensation Claims Operations Analyst

  • Job ID: 512334703
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: HB Wrkrs Comp Risk Cntrl
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $24.78 to $42.84 / hour

Description

UPMC Workpartners' Workers Compensation group is seeking a Claims Operations Analyst!


The Commercial Workers' Compensation Claims Operations Analyst (WCCOA) reports to the Workers' Compensation Program Administrator. The WCCOA is responsible for providing operational support to the Claims Department. The WCCOA will also provide assistance to the other functional areas through customer service and administrative support. The WCCOA provides operational and administrative support within established performance standards and priorities that are responsive to marketing, claims management, risk management, retention and service goals. The WCCOA assures all related support activities are delivered in a manner consistent with business unit customer service and expense management focus.

This role is a great opportunity to work with and provide operational support to several internal departments, to take a deeper dive into business strategies, and how the dept’s/programs fit into the bigger picture to serve clients.  Each day will vary and present new situations in which to learn and grow professionally.

This position is in the Steel Tower in downtown Pittsburgh or Remote. 

Responsibilities:

  • Develop operational workflows, protocols, and procedures for all units within the Claims Department.
  • Understand Claims' needs and requirements in relation to the functional system that are being used system applications.
  • Produce supporting statutory reporting documents (WCAS).
  • Provide assistance with On-Boarding new Workers' Compensation insureds
  • Prepare and deliver all claims management reports ensuring promptness and accuracy.
  • Analyze Claims information from data reports to help identify claims trends and movements.
  • Act as a Claim champion for projects that affect claims structure and workflow, including system related matters, to ensure operational efficiency.
  • Providing additional administrative support as required.
  • Act as a key contributor to the weekly and monthly reporting process, including the production of key deliverables for senior leadership and their management teams.
  • Perform special projects of varying complexity as requested.
  • Review insured provider panel compliance within the first 90 days and troubleshoot deviations.
  • Serving as a customer service representative for the Claim department by promptly and professionally addressing customer questions and concerns.
  • Participate in requirement and report design sessions with cross-functional teams.
  • Develop and produce accurate, consistent, and timely reports and analyses for Commercial Claim Reviews.
  • Assist with coordination of service calls for identified clients.
  • Prepare, generate and review all reports and presentations as needed.
  • Review and troubleshoot claims workflow problems related to systems and process issues.
  • Support the monitoring of Claims Shared Service and Outsource Service Providers.
  • Create efficiencies by recommending alternative workflows.
  • Connect Claims' operational requirements to System support. This will involve being a Claims Liaison person with IT to get system related resolution.
  • Help the department achieve operational alignment and consolidation.

 

Qualifications

  • Bachelor's Degree in business or technical discipline and four (4) years related experience
    • or equivalent combination of education and work experience
  • Ability to identify problems or opportunities; understand issues; identify cause/effect relationships and explore alternative solutions to support sound decision-making.
  • Proficiency in Microsoft Office (Excel, Word and PowerPoint) skills required
  • Demonstrated analytical/problem solving and research skills.
  • Excellent verbal and written communication skills Strong organizational and time management skills.
  • Effective communication skills. Relationship Management: Seeks out, builds, fosters and maintains productive relationships, networks or alliances to meet goals and achieve results.
  • Teamwork: Works together in situations when actions are interdependent and a team is mutually responsible to produce a result.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct