As a
Senior Business Configuration Solutions Analyst, you'll play a critical role in shaping how UPMC Health Plan's core systems support its products, members, and operations-today and into the future.
In this role, you'll oversee and optimize administrative and system processes that power our transactional platforms across all UPMC Health Plan products. You'll take a leadership role in major system initiatives, including the modernization of the CoreAdministration Processing System (CAPS) and the migration from our legacy platform to Cognizant QNXT. Your work will ensure accurate configuration, business readiness, and operational stability throughout the transition.
As a trusted subject matter expert, you'll partner closely with business leaders, technical teams, vendors, and external stakeholders to identify opportunities, design solutions, and guide execution. You'll also mentor team members-helping develop talent, sharing expertise, and driving consistent, high-quality outcomes.
This is a hybrid role with a 3 day a week in office requirement. What You'll Do - Lead the administration, configuration, testing, auditing, and implementation of transactional claims processes for internal clients and TPA business
- Support CAPS modernization and migration to Cognizant QNXT, including configuration buildout, testing, conversion validation, and go-live readiness
- Translate business requirements into system designs and enhancements, ensuring alignment with operational and customer needs
- Drive solution selection by conducting vendor research, supporting RFPs, facilitating demos, and defining evaluation criteria
- Collaborate across business, IT, security, compliance, legal, and contracting teams to review requirements and ensure alignment
- Audit business requests to confirm configurations comply with plan design, schedules of benefits, and reimbursement requirements
- Analyze data to identify risks, trends, or gaps that may impact client satisfaction, compliance, or financial outcomes-and propose actionable solutions
- Work closely with developers and testers to ensure requirements are accurately translated into functional technical solutions
- Manage requirements gathering, prioritization, and negotiation to ensure delivered solutions meet or exceed expectations
- Support system integration activities related to CAPS-to-QNXT migration, including coordination, testing validation, and production readiness
- Identify root causes of issues, assess member and financial impact, and implement effective resolution strategies
- Ensure controls are in place and monitored to meet regulatory standards and UPMC policies
- Maintain and annually review departmental policies and procedures, making updates as needed
- Take an active mentorship role by coaching, developing, and supporting team members
- Participate in enterprise-wide initiatives and perform additional duties as assigned
What You Bring - Hands-on experience with Core Administration Processing Systems, specifically Cognizant QNXT
- Proven experience supporting or leading system migrations (legacy platforms to QNXT), including data mapping, configuration, testing, and validation
- Strong understanding of claim adjudication logic, pricing methodologies, coordination of benefits (COB), and payment integrity
- Proficiency in SQL or similar query tools for research, validation, and troubleshooting
- Working knowledge of EDI transactions (837, 835, 834, 820, 270/271)
- Experience using requirements and work management tools such as Jira, Azure DevOps, ServiceNow, and Confluence
- The ability to communicate complex technical concepts clearly to both technical and non-technical audiences
- A collaborative mindset paired with the confidence to lead, influence, and drive change
Why This Role Matters This is more than a configuration role-it's an opportunity to shape enterprise-scale systems, influence how critical healthcare operations function, and help guide a major platform transformation. If you're energized by complex problem-solving, cross-functional leadership, and mentoring others while driving meaningful impact, this role was built for you.
Qualifications:• Bachelor's Degree or equivalent work experience.
• Minimum of 6 years general business experience.
• Understanding of XML data structure.
• 3 or more years of experience with Core Administration Processing Systems, specifically Cognizant QNXT is highly preferred.
• Hands-on experience supporting or leading a system migration (e.g., legacy platform 12 QNXT), including data mapping, configuration buildout, conversion validation, and parallel testing.
• Strong understanding of claim adjudication logic, pricing methodologies, COB, and payment integrity functions highly preferred.
• Proficient in SQL or similar query tools for data validation, research, and troubleshooting.
• Familiarity with EDI transactions (837, 835, 834, 820, 270/271) highly preferred.
• Experience using requirements management tools (Jira, Azure DevOps, ServiceNow, Confluence) highly preferred. .
Licensure, Certifications, and Clearances: 
