UPMC Health Plan has an exciting opportunity for a Business Analyst position in the CHC Service Coordination department. This is a full time position working Monday through Friday daylight hours. May be required to work weekend and evening shifts on occasion for business needs.
Must be located in PA and have the ability to travel into the office on occasion. We are seeking candidates with a strong background in managed care reporting, LTSS service authorization processes, compliance-focused quality review, and data analysis. This role requires an individual who is detail-oriented, comfortable conducting extended research, skilled in Excel and Power BI reporting tools, and able to communicate findings clearly to cross-functional, regulatory, and executive stakeholders.
The ideal candidate should also be comfortable working in a fast-paced environment that may require extended hours, flexibility, and the ability to meet tight deadlines and project timelines. Experience with Home Modification processes is highly preferred. Community HealthChoices (CHC) is Pennsylvania's managed care long term services and supports (LTSS) program serving seniors and individuals with physical disabilities in the Commonwealth who are covered by Medicare and Medicaid.
Effectively prioritize and complete all assigned tasks. Work with users and developers to identify problems and propose solutions. Identify areas of concern that may compromise client satisfaction.
Maintain employee/insured confidentiality. Maintain project planning, model business requirements for new systems and enhancements to existing systems. Ability to analyze benefit administration issues to determine the need for and the scope of polices and procedures.
Develop administration policies and procedures or business recommendations to ensure uniform, cost effective claims administration practices that comply with the law, plan documents and other company policies. Participate in training programs as available/requested. Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork.
Assist other departments during periods of backlogs. Bachelor's degree or equivalent related work experience required. Minimum of two years of general business experience required.
Minimum of two years of experience in business/industry specialty required. Knowledge of commercial, Medicaid, and Medicare products preferred. Competent in MS Office and PC skills preferred.
Working knowledge of COB (Coordination of Benefits) preferred. Organizational, interpersonal, and communication skills required. Licensure, Certifications, and Clearances: Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran