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 Sales Operations Management team, this role will analyze, identify, propose, and implement solutions for all Commercial Products 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, Expert must use their knowledge and understanding of financial, operational, clinical and other information generated by numerous sources to identify opportunities to improve clinical, operational 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.
This role is eligible for long-term partial work from home privileges, (privilege eligibility is subject to continued achievement of business goals and on-site department needs).
- Administer, identify, test, audit, and implement new processes on Commercial systems
- Model business requirements for new systems, special projects, and enhancements to existing systems; validate and test fixes/enhancements to new and existing systems
- Serve as the Product Owner for the Salesforce instance and coordinate with internal IT and Salesforce resources for major updates, enhancements
- Identify areas of concern that may compromise client satisfaction through data analysis, and propose solutions based on findings, expertise, and research
- Actively identifies and implements work process improvements to enhance team and department performance
- Maintains and updates Salesforce 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
- Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork
- Provides support to Operations Analysts
- Takes a leadership role in mentoring and motivating staff building a strong cohesive team
- Identify appropriate resources and support needed to facilitate decisions to achieve optimal outcomes
- Interface with customers by telephone, correspondence, and or in-person to answer inquiries and resolve
- Manages special projects as assigned by Management team; develops/maintains project plans, as needed
- Manages, updates, and maintains source data dictionaries as they relate to processes
- Completes Executive Summary management documentation as required
- Completes inquiries generated from the data reporting and analysis area
- Meets deadlines and turnaround times set by Management staff which may, at times, require an employee to work extended hours until completion of project
- Assists other departments during periods of backlogs
- Attends meetings on behalf of Manager/Director
- Participates in training programs when available/as requested
- Maintain employee/insured confidentiality
- Bachelors Degree or equivalent work experience.
- Minimum seven 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.
- Expert competence of the most common features of specialized analysis and reporting tools, eg SQL, SSIS, Oracle, and MS Office Suite.
- 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.
- Salesforce Admin Certification within 180 days of hire is preferred.
Licensure, Certifications, and Clearances:
- UPMC is an Equal Opportunity Employer/Disability/Veteran
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.
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.