Operations Analyst, Senior - Hybrid

UPMC Senior Communities • $80K — $95K *
Pittsburgh, PA 15237Hybrid
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's Degree or equivalent work experience
  • Minimum five years general business experience
  • Preferred experience in health care insurance or industry, relevant experience in other fields considered
  • Preferred knowledge of Commercial, Medicaid, Medicare, and Individual products
  • Competence in MS Office, especially Excel, Access, and Word
  • Excellent communication, documentation, analytical, and problem-solving skills
  • Ability to thrive in a fast-paced environment
  • Strong interpersonal, organizational, and project management skills

Responsibilities

  • Maintain employee/insured confidentiality
  • Complete inquiries from data reporting and analysis
  • Participate in available training programs
  • Provide support to Operations Analysts
  • Complete Executive Summary documentation as required
  • Identify and implement work process improvements
  • Manage special projects and develop project plans as needed
  • Interface with customers to resolve inquiries and concerns
  • Mentor and motivate staff to build a cohesive team
  • Administer and implement new processes on transactional claims systems
  • Identify areas of concern through data analysis and propose solutions

Benefits

  • Full-time hybrid position
  • Opportunity to lead special projects
  • Engaging work environment with training programs
  • Collaborative team culture
  • Chance to contribute to clinical and financial performance improvements
  • Employee confidentiality maintained
  • Flexible work hours during project completions
Full Job Description
UPMC Health Plan has an exciting opportunity for an Operations Analyst, Senior position in the Core System Operations department. This is a full-time hybrid position based in the Pittsburgh area.
This role oversees administrative, system processes and special projects as they relate to implementation and maintenance of the claims transactional system as well as 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, Senior 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.

Responsibilities:
  • Maintain employee/insured confidentiality
  • Performs other duties as assigned
  • Completes inquiries generated from the data reporting and analysis area
  • Participates in training programs when available/as requested
  • Provides support to Operations Analysts
  • Completes Executive Summary management documentation as required
  • Actively identifies and implements work process improvements to enhance team performance
  • Assists other departments during periods of backlogs
  • Performs in accordance with system-wide competencies/behaviors
  • 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
  • Manages special projects as assigned by Management team; develops/maintains project plans, as needed
  • Attends meetings on behalf of Manager/Director
  • Interface with customers by telephone, correspondence, and or in person to answer inquiries and resolve concerns/issues
  • Manages, updates, and maintains source data dictionaries as they relate to processes
  • Model business requirements for new systems, special projects and enhancements to existing systems; validate and test fixes/enhancements to new and existing systems
  • Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork
  • Takes a leadership role in mentoring and motivating staff building a strong cohesive team
  • Administer, identify, test, audit and implement new processes on transactional claims systems
  • Meets deadlines and turnaround times set by Management staff which may, at times, require an employee to work extended hours until completion of project
  • Identify areas of concern that may compromise client satisfaction through data analysis, and propose solutions based on findings, expertise, and research
  • Identify appropriate resources and support needed to facilitate decisions to achieve optimal outcomes


Qualifications:

  • Bachelor's Degree or equivalent work experience.
  • Minimum five years general business experience.
  • 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.
  • Experience in QA/Audit/Systems testing development and execution preferred.
    Licensure, Certifications, and Clearances:
  • Act 34

About UPMC Senior Communities

UPMC Senior Communities Careers

There has never been a better time to explore the diverse job opportunities at UPMC Senior Communities—the leading network of senior living facilities focused on innovative care and professional excellence.

Work You’ll Do

Join UPMC Senior Communities to assist in transforming the experience of aging through top-tier care and wellness programs. This is an opportunity to be part of a team that values leadership, diversity, and innovation in the healthcare sector. Lead in a unique role where skills in healthcare, empathy, and leadership converge to enhance the lives of seniors. UPMC Senior Communities stands at the forefront of the industry, integrating advanced technology and personalized care practices. Engage with a professional network of healthcare providers and administrators dedicated to pioneering improvements in senior living. Collaborate with over 3,000 dedicated professionals across various facilities.

Introducing the UPMC Senior Communities Professional Development Program

The program is designed to foster career growth through comprehensive training, leadership development, and diversity training. UPMC Senior Communities is committed to nurturing the professional growth of its team members through continuous education and opportunities for advancement.

Do Innovative Work

Be part of a culture that thrives on innovation and continuous improvement. UPMC Senior Communities employs a vast array of healthcare professionals and support staff, all dedicated to setting new standards in senior care.

Drive Change in Senior Healthcare

Deliver targeted solutions and personalized care that significantly improve the quality of life for residents. UPMC Senior Communities offers a platform for professionals to apply their expertise in a meaningful and impactful way.

Be Part of a Great Team

Work alongside a team that values compassion and professionalism, harnessing the collective capabilities to deliver exceptional care. UPMC Senior Communities promotes a collaborative environment where every team member’s contribution is valued.

Future-Proof Your Career

Advance your career within UPMC Senior Communities through a variety of pathways, from direct care positions to administrative roles. Enjoy robust benefits, professional development programs, and a supportive work environment that encourages long-term career growth.

Explore

Discover how UPMC Senior Communities leads the way in senior healthcare innovation: - Implementing cutting-edge health technology to enhance resident care - Developing community-based programs that support holistic wellness

The UPMC Senior Communities Employment Promise

With a commitment to employee satisfaction and career development, UPMC Senior Communities ensures that all team members have the resources and support to succeed. Clients and their families rely on UPMC Senior Communities for compassionate and skilled care, making it a prime choice for those seeking meaningful employment in the healthcare sector.

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* Ladders Estimates

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