Associate III - BPM- PDM

About The Job:

• The Provider Data Management (PDM) Analyst is responsible for reviewing, validating, updating, and maintaining accurate provider information within a Business Process Management (BPM) environment according to approved Client processes and procedures.
• The role supports outreach verification, returned mail, credentialing record updates, and PIMS claim-related provider setup while meeting quality, productivity, documentation, turnaround-time, and SLA requirements.

Essential Job Functions:
Provider Data Review & Maintenance

• Review provider update requests from preferred and non-preferred providers.
• Validate and update provider demographics, addresses, specialties, affiliations, practice locations, and related provider records.
• Retain provider correspondence, telephone notes, system records, and supporting evidence.
• Identify incomplete, inconsistent, or conflicting information and follow established escalation procedures.
• Perform activities in accordance with defined BPM workflows, process controls, and operational guidelines.

Outreach Verification

• Contact providers by email or telephone when needed to confirm the accuracy of requested updates.
• Document outreach attempts, responses, and final validation outcomes.
• Complete outbound calls for cases requiring verbal confirmation.
• Ensure updates are supported by appropriate evidence before closure.

Returned Mail

• Review returned mail cases when the postal service cannot identify a valid addressee or delivery address.
• Validate provider address information using approved procedures and sources.
• Update applicable systems and retain supporting evidence.
• Escalate unresolved discrepancies or potential network-access concerns.

Credentialing Record Updates

• Review records returned by the credentialing vendor.
• Complete credentialing record updates according to approved policies and procedures.
• Validate required documentation and identify missing or inconsistent information.
• Support recredentialing activities including application review, expirable monitoring, primary source verification, and compliance checks when assigned.

PIMS Claims Support

• Review claims pended because a group or practitioner is not loaded in the claims system.
• Research and load missing provider information into the designated provider system according to approved procedures.
• Validate that provider information is complete and accurately entered to enable downstream claims processing.
• Escalate records that cannot be resolved using available documentation and approved sources.

Workflow, Quality & Reporting

• Manage assigned inventory and meet productivity, quality, SLA, and turnaround-time expectations.
• Perform self-quality checks and resolve identified defects promptly.
• Update trackers, dashboards, case notes, and status records accurately.
• Support backlog reduction, aging control, audit requests, and continuous improvement activities.
• Participate in BPM quality initiatives, process improvement programs, and operational excellence activities.

Qualifications:
Mandatory Skills & Competencies

• Knowledge of US healthcare payer provider data management, credentialing, or provider operations.
• Understanding of provider demographics, specialties, affiliations, practice locations, NPI information, and credential records.
• Familiarity with CAQH, NPPES, state licensing sources, OIG, and NPDB, as applicable.
• High attention to detail and strong documentation accuracy.
• Effective provider outreach, analytical, problem-solving, and escalation skills.
• Ability to work within high-volume queues and SLA-driven BPM operations.
• Understanding of BPM processes, workflow adherence, quality standards, and productivity metrics.

Education

• Bachelor's degree in Healthcare Administration, Business, Life Sciences, or a related field preferred.

Experience

• 3 to 6+ years in US healthcare provider data management, credentialing, recredentialing, or provider operations.
• Experience in healthcare payer or BPO/BPM operations preferred.

Preferred Tools & Systems

• Provider information management and payer administration systems.
• CAQH, NPPES, OIG, NPDB, state licensing sources, and Microsoft Excel, as applicable.

How to Apply: Interested candidates are encouraged to respond/submit their updated resumes, and for additional job opportunities, please visitJobs In India – VARITE.

Unlock Rewards: Refer Candidates and Earn.

If you're not available or interested in this opportunity, please pass this along to anyone in your network who might be a good fit and interested in our open positions. VARITE offers a Candidate Referral program, where you'll receive a one-time referral bonus based on the following scale if the preferred candidate completes a three-month assignment with VARITE.

Experience Level Bonus Referral:

• 0-2 years - INR 5,000
• 2-6 years - INR 7,500
• 6+ years - INR 10,000

About VARITE: VARITE is a global staffing and IT consulting company providing technical consulting and team augmentation services to Fortune 500 Companies in USA, UK, CANADA and INDIA. VARITE is currently a primary and direct vendor to the leading corporations in the verticals of Networking, Cloud Infrastructure, Hardware and Software, Digital Marketing and Media Solutions, Clinical Diagnostics, Utilities, Gaming and Entertainment, and Financial Services.

Equal Opportunity Employer:

VARITE is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, marital status, veteran status, or disability status.