Member C&G Business Analyst, DHS and Commercial (Hybrid)- Pittsburgh, PA

UPMC Health Plan has an exciting opportunity for a Member C&G Business Analyst I position for the Member CGA department. This will be a full time position working Monday through Friday 8:00 a.m. to 4:30 p.m. This is considered a hybrid position, although you will work from home but may be required to go into the office for meetings and other business needs.

The Business Analyst I will collaborate with users and developers to identify problems and propose solutions. Maintain project planning documents, prepare materials, write, and distribute workflow, maintain UPMC (University of Pittsburgh Medical Center) systems portfolio (checklist). Successfully use knowledge and expert understanding generated by numerous sources to identify opportunities to improve performance. Ability to articulate these opportunities to internal and external audiences, implement the solutions, and track and monitor progress. 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.

Responsibilities

• Maintain employee/insured confidentiality.
• Participate in training programs as available/requested.
• Identify areas of concern that may compromise client satisfaction.

Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork.

Strong Line of Business knowledge – able to be a point of contact for coordinators and leadership if reporting questions arise.

Assist other teams during periods of backlogs.

Mentor new C&G (Complaints and Grievances) staff by creating shadowing opportunities, one-on-one training, and providing recommendations on employee growth.

• Monitor quality of C&G Coordinators, identify errors, and provide feedback to leadership.
• Develop training materials for Coordinators and other C&G staff.

Collaborate with department leadership to ensure processes are current and protocols are being consistently implemented.

Manage small special projects, as assigned by management, for the benefit of C&G and the Insurance Services Division.

Complete External Grievances and External Complaints daily, including submission to IROs/EROs and Identify opportunities to avoid problematic overturns by the external reviewer.

Participate in department audits, including risk-assessment, timely-submission, and gathering of requested information.

Analyze C&G data to identify trends and opportunities to reduce costs and increase member satisfaction.

Effectively prioritize and complete all assigned tasks. Consistently attains expected and timely results.

Collaborate with users and developers to identify problems and propose solutions.

Able to plan, anticipate problems, takes initiative, and takes appropriate action when needed – able to get direction and lead what is assigned to completion with minimal supervisor oversite.

Maintain project planning, model business requirements for new systems and enhancements to existing systems.

Actively identifies areas of opportunities to either streamline processes or eliminate unnecessary steps of a process.

• 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.
• Knowledge of the Complaints and Grievances current system of record is preferred.

Computer Software Skills

Health Plan systems of record for C&G, Pharmacy, Utilization Management, Member Services, Claims, and CHC (Community Health Choices);

Microsoft Office including Word, Outlook, Excell, Forms, Visio, and PowerPoint; QWERTY keyboard proficient; ability to navigate Power BI.

Licensure, Certifications, and Clearances

UPMC is an Equal Opportunity Employer/Disability/Veteran