Job Details

UPMC Health Plan has an exciting opportunity for an Administrator, Third Party Compliance position in the TPCO department. This is a full time position working Monday through Friday 9 a.m. to 5 p.m. This will be a hybrid position consisting of working from home and in office.

The Admin,Third Party Compliance reports to the Manager, Third Party Compliance Oversight. This position monitors and evaluates the performance of delegated third parties to ensure ongoing compliance with CMS, federal, and state requirements, as well as contractual obligations. The role partners closely with business and operational leaders, leveraging strong analytical, communication, and relationshipbuilding skills to identify and mitigate risk, drive corrective actions, and enable compliant, efficient operations.

Responsibilities:

• Build effective relationships with internal stakeholders and external third parties to ensure adherence to federal/state regulations and contractual requirements.
• Execute the annual TPCO auditing and monitoring plan, including riskbased assessments and required attestations for delegated entities.
• Maintain complete and current oversight documentation (e.g., inventories, risk ratings, attestations) and support internal/external audits and regulatory inquiries.
• Develop, enhance, and socialize reporting, dashboards, and metrics that monitor thirdparty performance, risk trends, and leading indicators.
• Identify issues and oversee corrective action plans (CAPs) through timely closure, validating remediation and sustainability.
• Monitor and communicate new or updated regulatory requirements to business partners; drive implementation activities and confirm operational readiness.
• Prepare clear, concise updates for leadership on oversight activities, risks, and trends; recommend datadriven actions.
• Support crossfunctional initiatives that strengthen compliance, operational alignment, and vendor performance.
• Provide direct support to the Manager, Third Party Compliance Oversight including managing the overall TPCO program, preparing presentations and leadership updates, facilitating key meetings, tracking action items and milestones, and escalating risks/issues appropriately.

• Bachelor's degree required.
• Minimum of 4-5 years of delegation oversight, vendor management, healthcare government programs, and/or compliance experience required, preferably on the insurance (payer) side.
• Strong subject matter expertise and knowledge of all relevant laws, regulations, contractual requirements, industry standards and best practices required.
• Strong acumen and understanding of healthcare, health insurance and managed health care industries and organizations required.
• Excellent oral, listening and written communication skills.
• Strong project management skills and experience required.
• Must have strong analytical and organizational skills as well as problem-solving capabilities to ensure that business plans and strategies do not subject the organization to legal, regulatory or contractual violations and/or undue risk or exposure.
• Strong partnership, relationship- consensus and coalition-building skills required.
• Strong emotional intelligence and self-awareness required.
• Strong strategic, business, operational and leadership mindset and skills required.
• Highly consultative and partnership-oriented in approach.
• Ability to interact with all levels of leadership, influence change, adoption of third-party compliance oversight concepts, and lead cross-functional initiatives.
• Strong and reliable judgment and discretion required.
• Strong ability to independently and self-sufficiently identify, navigate and successfully resolve various issues.
• Strong ethical compass and integrity capital required.
  Licensure, Certifications, and Clearances:
• Act 34
• Not required; relevant audit and industry certifications considered a plus.