UPMC Health Plan has an exciting opportunity for a Quality Assurance Operational Integrity position. This is a full-time position working Monday through Friday daylight hours. This is a hybrid position with requirements and expectations to be discussed during the interview process.
The QAOI, Intermediate will conduct quality assurance and operational integrity assessments and reviews across the Insurance Services Divisions’ portfolio of products, services, and functional departments, supporting ISD stakeholders and leadership to mitigate risks, ensure operational integrity, and compliance in the achievement of initiatives, business goals, and objectives. The QAOI, Intermediate is primarily responsible for planning, executing, and reporting on assigned annual focused reviews and business/operational/financial controls across the ISD, as determined by leadership, and reported to the Executive Leadership and Board of Directors.
Additionally, the incumbent may lead small scale QA initiatives, projects, and workgroups including conducting root cause analyst and preparing actional data reports that provides insight and value to ISD Stakeholders.
Exhibits professionalism in protecting and building the department’s brand. This includes contributing to a positive QAOI work community modeling department tenets, as well assisting in identifying opportunities for process improvements within the department. Successfully demonstrate competency in executing the audit process, risk management framework, selecting and applying appropriate statistical methodology for population sampling and confidence levels.
Meets departmental standards for quality and internal operational integrity. Demonstrates accurate, thoroughly, and timely completion of assignments. Has built a solid internal network of partners and SMEs across the ISD, as well as maintains specialized certification and keeps up with industry and specialized best practices and protocols as appropriate.
Can serve as a stakeholder QAOI consultant. Readily identifies and uses source documents to assess appropriate outcomes, integrity, and root cause on assigned targeted reviews, and business/financial/operational/IT controls. Defines scope, verify requirements/deliverables for review activity including planning coordinating, participating in meetings, and following through to assignment completion (including mock audits).
Prepares accurate and thorough finding reports/workpapers with consistent correct spelling, grammar, and organization. Tracks and performs follow-up for past work. Leads small scale initiatives, workgroups, mock audits.
Successfully interacts and establishes credibility with stakeholders including maintaining independence and selecting the appropriate meeting formats. Understands the organization structure and how applies to work, as well as ISD initiatives that may impact work. Performs other duties as assigned and performs in accordance with system-wide competencies/behaviors.
Bachelor’s degree and/or equivalent experience. 6 years’ experience (quality assurance, operational controls, risk management, auditing, or customer service) or CIA certification with 2 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 preferred.
Ability to comprehend and apply relevant information to tasks and assignments. Detailed oriented with strong critical thinking skills, analytical skills, and basic project management skills. Excellent oral, written, and reporting communication skills.
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 learn data extraction and data extraction tools. Licensure, Certifications, and Clearances: CIA preferred. UPMC is an Equal Opportunity Employer/Disability/Veteran