Business Analyst- Remote

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.

• 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.

• 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