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UPMC is an Equal Opportunity Employer/Disability/Veteran.
Business Analyst- Remote
Location
United States
Posted
73 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Business Analyst- Remote
UPMC
UPMC Health Plan has an exciting opportunity for a Business Analyst position in the Fraud, Waste & Abuse department. This is a full time position working Monday through Friday daylight hours. This is a remote position. The Business Analyst supports the UPMC Health Plan Special Investigations Unit (SIU) and Fraud, Waste & Abuse (FWA) activities through advanced data analysis, risk‑based monitoring, and regulatory reporting. This role partners with Claims, Legal, Compliance, and IT to identify program integrity risks and support healthcare investigations and audits. Responsibilities: - Analyze large, complex healthcare datasets to identify patterns, trends, and potential fraud, waste, and abuse - Develop and maintain risk‑based monitoring and executive‑level dashboards - Create metrics, trend analyses, and regulatory reports (Medicaid, Medicare, FEHB, CHIP) - Pull and analyze claims and operational data to support audits and investigations - Develop RAT‑STATS samples and perform extrapolation analyses - Translate business needs into data‑driven insights and reporting solutions - Maintain documentation, workflows, and project materials - Ensure data accuracy, confidentiality, and compliance with regulatory requirements - 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 Advanced Excel skills preferred. - Organizational, interpersonal, and communication skills required. Preferred Qualifications: - Experience in Health Insurance, Claims Operations, FWA/SIU preferred. - Highly organized with strong attention to detail - Knowledge of CPT, HCPCS, and ICD‑10 coding and common FWA schemes preferred. - Strong analytical skills with the ability to communicate findings to executive audiences preferred. - Experience creating dashboards, reports, and compliance documentation preferred. Licensure, Certifications, and Clearances: - Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran
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TDTD Insurance is part of TD Bank Financial Group, one of Canada’s largest financial institutions. TD Insurance helps protect clients from the ‘accidents of life’ with a wide range of products including: Credit protection Life, health, travel, home, and auto insurance With more than three million clients, TD Insurance authorized products and services are available online, over the phone, and through a network of more than 1,000 TD Canada Trust branches. At TD Insurance, we are committed to fostering an inclusive, accessible environment, offering a stable and dynamic work environment where talent is appreciated and professional development is taken seriously.
Work Location: Wilmington, Delaware, United States of America Hours: 40 Pay Details: 72,280 - 108,160 USD TD is committed to providing fair and equitable compensation opportunities to all colleagues. Growth opportunities and skill development are defining features of the colleague experience at TD. Our compensation policies and practices have been designed to allow colleagues to progress through the salary range over time as they progress in their role. The base pay actually offered may vary based upon the candidate's skills and experience, job-related knowledge, geographic location, and other specific business and organizational needs. As a candidate, you are encouraged to ask compensation related questions and have an open dialogue with your recruiter who can provide you more specific details for this role. 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Senior Technical Business Analyst
Monogram HealthA leading multispecialty provider of in-home, evidence-based care and benefit management services.
• Under general direction of the Technical Product Manager, the Senior Technical Business Analyst (TBA) will bridge the gap between business needs and technical solutions by gathering, analyzing, and translating business or clinical ambiguity into a well-scoped modeling problem • Work with a product owner mindset, framing the decisions that a model is supposed to impact • Take ownership of the user story backlog to ensure deliverables meet requirements and quality standards • Lead the creation of clear requirement artifacts, serve as primary point of contact for stakeholders, lead testing efforts, work closely with development teams, and help craft executive summaries and demos of new or in-flight work
Role Description We are seeking a Business Analyst (BA) to play a key role in defining, shaping, and validating the requirements for an enterprise‑wide action and approval orchestration platform. The Business Analyst will act as the bridge between business stakeholders and technology teams, ensuring that business needs are clearly translated into scalable, implementable solutions. The ideal candidate has strong experience in process analysis, approval workflows, stakeholder management, and system implementation programs, with a focus on delivering measurable business outcomes. Key Responsibilities - Business Discovery & Requirement Analysis - Work with business stakeholders to understand current approval and decision‑making processes - Identify pain points, inefficiencies, and manual dependencies - Capture functional and non‑functional requirements - Define success metrics and business KPIs - Use Case & Process Definition - Identify and document high‑value approval and action use cases - Define triggers and events, decision points and approvers, timelines and escalation paths - Create clear future‑state (“to‑be”) process flows - Requirements Documentation - Prepare clear and concise documentation, including business requirement documents (BRDs), user stories and acceptance criteria, process flows and decision matrices - Maintain traceability between business requirements and delivered functionality - Stakeholder Engagement & Facilitation - Facilitate workshops and requirement‑gathering sessions - Act as the primary liaison between business teams, product managers, architects, and engineering teams - Manage scope discussions and change requests - Support Design & Development - Validate detailed designs against business requirements - Clarify requirements during development - Support prioritization decisions for MVP vs Phase‑2 - Ensure business logic is correctly implemented - User Acceptance Testing (UAT) Ownership - Lead UAT planning and execution on behalf of the business - Define UAT scenarios and test cases - Coordinate UAT users and sessions - Validate outcomes and manage sign‑off - Track and prioritize business defects - Change Management & Adoption Support - Support communication and training planning - Gather user feedback and adoption insights - Help prepare rollout and go‑live readiness - Support hyper‑care and early stabilization Qualifications - 6+ years of experience as a Business Analyst - Proven experience on enterprise application or platform implementations - Strong background in workflow, approval, or decision‑centric systems Requirements - Core Experience - Business process modeling (As‑Is / To‑Be) - Requirements elicitation and documentation - Use case and user story definition - Data and decision logic analysis - UAT planning and execution - Technical Awareness (Not a Developer Role) - Working knowledge of APIs and system integrations - Event‑driven or workflow‑based systems - Role‑based access and approval logic - Ability to collaborate effectively with architects and engineers - Tools & Methodologies - Agile / Scrum or hybrid delivery models - BPMN / process flow tools - Jira, Confluence, or equivalent tools - Basic reporting and dashboard tools - Soft Skills & Mindset - Strong communication and facilitation skills - Ability to work with senior business stakeholders - Structured thinking and attention to detail - Pragmatic and outcome‑driven approach - Comfortable managing ambiguity in early project phases
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