Provider Services Associate II

Responsible for reviewing, validating, and correcting healthcare provider information as part of BPM operations. The role focuses on maintaining accurate provider data, meeting defined quality and productivity targets, and completing assigned activities within established SLAs and process guidelines.

Key Roles and Responsibilities

• Provider Data Validation: Review provider information such as demographics, credentials, network status, and payment-related details and identify discrepancies or incomplete information.
• Data Correction: Update and correct provider records accurately based on defined process guidelines and standard operating procedures.
• Process Execution: Complete assigned transactions within agreed SLA, productivity, turnaround time, and quality standards.
• Quality Assurance: Perform required quality checks to ensure provider information is complete and accurate.
• Issue Resolution: Research data discrepancies, identify recurring issues, and escalate complex cases to the appropriate team or supervisor.
• Documentation: Maintain accurate records of transactions, corrections, and outcomes as required by the process.
• Compliance: Follow applicable healthcare data privacy, security, and compliance requirements, including HIPAA.
• Collaboration: Coordinate with team members, leads, and other stakeholders for timely resolution of provider data issues.
• UST Values: Uphold UST values of Integrity, Customer Centricity, Innovation, Collaboration, Excellence, and Respect.

Required Skills and Qualifications

• Experience: 3+ years of experience in BPM/BPO operations or data processing, preferably in the US healthcare or health insurance domain.
• Good understanding of transaction processing, SLA, quality, and productivity metrics.
• Strong attention to detail and accuracy.
• Good analytical and problem-solving skills.
• Working knowledge of MS Office and data processing applications.
• Good verbal and written communication skills in English.
• Ability to work effectively in a team and handle process volumes within defined timelines.
• Amenable to work onsite and nightshift

Education

• College degree an advantage but not required