Role Description

At UST, we help the world’s best organizations grow and succeed through transformation. Bringing together the right talent, tools, and ideas, we work with our client to co-create lasting change. Together, with over 30,000 employees in 30+ countries, we build for boundless impact—touching billions of lives in the process. Visit us at .

Summary

UST is looking for….

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

Key Responsibilities 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.

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.

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 operations.

Qualifications 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 operations preferred.

Preferred

Tools &

- Systems




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

Key Performance

Indicators (KPIs)

- Processing accuracy and first-pass quality
- SLA and turnaround-time adherence
- Productivity attainment
- Inventory aging and backlog reduction
- Documentation completeness
- Rework and defect rate
- Timely escalation and case closure

What You Need BTech/ MCA/ BCA/Msc IT/Bsc IT

Required Skills

CAQH, Microsoft Excel, NPDB, Provider CredentialingPDM Analyst

What You Need

What we believe

We’re proud to embrace the same values that have shaped UST since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion and to place people at the centre of everything we do.

Humility

We will listen, learn, be empathetic and help selflessly in our interactions with everyone.

Humanity

Through business, we will better the lives of those less fortunate than ourselves.

Integrity

We honour our commitments and act with responsibility in all our relationships.

Equal Employment Opportunity Statement

UST is an Equal Chance Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion, or sexual orientation.

All employment decisions shall be made without regard to age, race, creed, colour, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

UST reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

- To support and promote the values of UST.
- Comply with all Company policies and procedures

Skills Role Summary The Provider Data Management (PDM)

Skills

CAQH, Microsoft Excel, NPDB, Provider CredentialingPDM Analyst

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