UPMC Health Plan has an exciting opportunity for a Business Solutions Configuration Analyst Associate position in the Dental Vision Ancillary department. This is a full-time hybrid position located in Pittsburgh, PA consisting of working from home and in office. The Business Solutions Configuration Analyst Associate is responsible for supporting the administration and operations of dental and vision products including systems configuration, implementation, project management, product oversight, vendor relations, and training.
Under the general direction of Ancillary Operations Management, this role will analyze, identify, propose, and implement solutions for all business areas. The Associate acts as subject matter expert supporting all areas and interacts with customers and staff to answer questions and resolve issues as they arise. Furthermore, the position requires the ability to articulate these opportunities to internal audiences, vendor contacts, and management and to implement the solutions, track and monitor progress.
The Associate will take a role in the enhancement, development, documentation, and communication of identified process improvements and system enhancements.
Administer, configure, test, audit, and implement new processes on transactional claims for both internal clients and TPA business. Model business requirements to implement new dental and vision products, which may include design of new systems or enhancements to existing systems that will support dental and vision product administration. Identify areas of concern that may compromise client satisfaction through data analysis, and propose solutions based on findings, expertise, and research.
Validate and test fixes/enhancements to new and existing systems, including vendor system upgrades. Conducting research on trends, incident reporting, and utilization reporting through Customer Service reporting, Incident Management Software, and reporting tools. Configure new dental and vision plans as requested by internal and external clients.
Completes audits of business requests to guarantee dental and vision configuration conforms with standards and conditions outlined within group's plan design, Schedule of Benefits and/or reimbursement requests. Participate in the design and implementation of reimbursement models for dentists and dental professionals. These schedules must be competitive in the market and actuarially sound, based on the premiums being offered to insured members.
Maintain fee schedules for updates, distributions, and retention as directed by department leadership for all lines of business including Commercial, Medicare, and Medicaid. Develop and generate reporting to support dental and vision operations and vendor oversight including utilization reporting, network, inventory management and ad hoc reporting as needed. Provide reimbursement data necessary to process claims for members of the Health Plan or resolve claims issues.
Work with departmental personnel to address all claims issues including problem resolution, rate configuration while considering system limitations, claims pending and manual pricing, and the incorporation of process efficiencies when applicable. Manages, updates, and maintains source data dictionaries as they relate to processes. Completes adjustments and/or other inquiries generated from internal and external clients, as well as the data reporting and analysis area.
Work closely with business partners and vendors to define strategies for technical solutions, determine requirements, and develop functional designs based on the analysis of line of business needs, objectives and existing systems infrastructure in an operational environment. Ability to create test plans. Ability to modify existing test plans.
Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork. Facilitate work group sessions with internal and external partners as needed. Performs in accordance with system-wide competencies/behaviors.
Performs other duties as assigned. Bachelor's Degree or equivalent work experience. Minimum of 4 years general business experience.
Understanding of XML data structure. Basic SQL statement knowledge. Licensure, Certifications, and Clearances: Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran