Quality Assurance Operational Integrity, Senior (Hybrid)- Located in Pittsburgh, PA

UPMC Senior Communities • $75K — $95K *
Pittsburgh, PA 15237Hybrid
Healthcare
5 - 7 years of experience
4 days ago
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Job Overview by Ladders

Qualifications

  • Bachelor's degree or equivalent experience required.
  • 7 years in quality assurance, operational controls, risk management, or auditing; or CIA certification with 3 years relevant experience.
  • Experience in auditing within heavily regulated industries, particularly healthcare, is essential.
  • Strong critical thinking, analytical, and project management skills encouraged.
  • Exceptional verbal and written communication skills with advanced business writing proficiency.
  • Detail-oriented with the ability to manage multiple priorities and meet deadlines.
  • Proficiency in MS Teams, Word, Excel, and willingness to learn Visio and auditing technologies.

Responsibilities

  • Conduct high-risk, complex audits with substantial impacts on members, providers, and finances.
  • Exhibit advanced competency in auditing processes and risk management methodologies.
  • Perform thorough root cause analysis on various control assessments.
  • Assist in compliance checks for SOC1, SSAE, and SOX regulations.
  • Coordinate and strategize new audits and risk-based audit planning with leadership.
  • Review peer audit assessments and maintain professional communication in representing the QAOI brand.
  • Mentor junior analysts and identify opportunities for process improvements within the department.

Benefits

  • Hybrid work environment with flexibility between home and office.
  • Full-time schedule with standard daylight hours from Monday to Friday.
  • Opportunities for career growth and professional development within a reputable healthcare organization.
Full Job Description
UPMC Health Plan is seeking a Quality Assurance Operational Integrity, Senior position. This is a full time position working Monday through Friday daylight hour. This is a hybrid position consisting of working from home and in office, which is located in Pittsburgh, PA.

Conduct quality assurance, operational integrity assessments and specialized reviews, and/or external audit management across the Insurance Services Divisions' portfolio of products, services, and functional departments, supporting ISD stakeholders and leadership to mitigate risks, ensure operational integrity, audit readiness/success and compliance in the achievement of initiatives, business goals, and objectives. The QA Analyst, Senior is primarily responsible for planning, executing, and reporting on complex/specialized targeted/focused reviews and business/operational/financial/IT controls, System Configuration, System implementations, SDLC testing validation, and Data File Validation or serving as the company liaison and project lead for all external audit activity across the ISD which includes executive and Board of Director reporting and communication. The QA Analyst, Senior controls multifunctional QAOI initiatives and workgroups or external audits focusing on specialized root cause analysis, and preparing actionable data reports that provides insight and value to ISD Stakeholders.

Responsibilities:

Audit Competency:
  • Assigned complex, highly-visible, high-risk, and critical focused process audits that have a high potential for impacts to members, providers, and UPMCHP's finances and reputation.
  • Successfully demonstrates advanced competency in executing the audit process, risk management, and selecting and applying statistical methodology for population sampling.
  • Utilizes source documentation to assess appropriate outcomes and integrity.
  • Performs extensive root cause analysis on complex assessments and business/financial/operational/IT controls.
  • Assists the QAOI Manager to ensure compliance with SOC1, SSAE, and SOX controls

Coordinator:
  • Assists the QAOI Manager with coordinating and assigning new audits.
  • Collaborates with QAOI leadership to develop and maintain a risk-based, second line of defense audit plan.
  • Serves as a peer or first reviewer of audit risk assessments, programs, workpapers, and reports.
  • Exhibits a professional demeanor in protecting and building the QAOI department's brand in meetings, workgroups, and other communications.
  • Mentors associate and intermediate analysts.
  • Remains cognizant of industry and regulatory changes to apply to risk-based audit plan.
  • Maintains working relationships with stakeholders across the ISD to remain abreast of changes that may create risks to the ISD.
  • Assists in identifying process improvements within the department


Qualifications:

  • Bachelors degree and/or equivalent experience.
  • 7 years experience (quality assurance, operational controls, risk management, auditing, or customer service) or CIA certification with 3 years related experience quality assurance, operational controls, risk management, auditing, or customer service.
  • Knowledge of a healthcare portfolio of products, services, and/or functional departments or experience auditing in a heavily regulated industry required.
  • Ability to comprehend and apply relevant information to tasks and assignments.
  • Detailed oriented with advanced critical thinking skills, advanced analytical skills, and solid project management skills.
  • Excellent oral, written, and reporting communication skills with advanced proficiencies in business writing concepts
  • Must possess a professional demeanor with the ability to manage multiple priorities and meet deadlines required.
  • Proficiency using MS Teams, Word, and Excel.
  • Ability to learn Visio and auditing technology.
  • Ability to apply data extraction and leverage data extraction tools.

Highly Preferred:
  • Advanced proficiency in Microsoft 365 Suite, particularly Microsoft Word and Excel.
  • Experienced in Governance Risk and Compliance platforms such as Archer, ServiceNow, OneTrust
  • CIA certification and 3 years of experience in the above skills.
  • Working knowledge of project management principles
  • Knowledge of healthcare portfolio of products, services, and/or functional departments highly preferred.
  • Demonstrated audit experience in a heavily regulated industry such as healthcare or finance is required.
  • Ability to manage multiple priorities and meet required deadlines
    Licensure, Certifications, and Clearances:
    CIA, Six Sigma, or Project Management preferred.

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