Role description

UST Title – Associate II - HealthPlan

Who we are:

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 Provider Recredentialing Specialist Shift Time : 5:30pm to 2:30am IST The Provider Recredentialing Specialist is responsible for managing the end-to-end recredentialing lifecycle for healthcare providers to ensure compliance with payer, regulatory, and accreditation requirements. The role focuses on periodic validation of provider credentials, documentation updates, and ongoing monitoring to maintain an accurate and compliant provider network. Recredentialing is a cyclical process that ensures providers continue to meet required standards through updated verification and monitoring activities.

Key Responsibilities

1. Recredentialing Lifecycle Management Manage end-to-end provider recredentialing processes in line with payer and regulatory timelines Initiate recredentialing cases based on due dates, expirable, and renewal triggers Track and manage provider credential expirations (licenses, certifications, malpractice insurance)
2. Documentation & Application Review Collect and review recredentialing applications via systems like CAQH or internal platforms Validate completeness and accuracy of provider documentation Follow up with providers for missing or inconsistent information
3. Primary Source Verification (PSV) Perform PSV for: Licensure Board certification Education & training Work history Validate data from authoritative sources (State Boards, NPPES, OIG, NPDB, etc.) Ensure compliance with regulatory and payer requirements
4. Background & Compliance Checks Conduct sanction and exclusion checks (OIG, NPDB, Medicare/Medicaid) Identify discrepancies, red flags, or compliance risks Escalate issues for further clinical or committee review
5. Provider Data Validation & Quality Checks Ensure accuracy of provider profile (specialty, affiliations, demographics, practice locations)



Perform quality audits on completed credentialing files Maintain documentation integrity for audit readiness
6. Workflow Management & Productivity Manage assigned inventory/queue ensuring SLA/TAT adherence Maintain productivity and quality benchmarks (first-time-right processing) Support backlog clearance and aging reduction initiatives
7. Stakeholder Coordination Interact with providers, internal teams, and external verification agencies Support escalations and provide status updates to clients/stakeholders Collaborate with QA, compliance, and operations teams
8. Reporting & Governance Update dashboards and trackers for recredentialing status and closures Highlight risks related to expirable, delays, or compliance gaps Support audit readiness and regulatory reviews Skills & Competencies Strong knowledge of: Provider Credentialing & Recredentialing lifecycle PSV (Primary Source Verification) CAQH, NPPES, NPDB, OIG processes Understanding of US healthcare payer operations High attention to detail and documentation accuracy Analytical & problem-solving mindset Strong communication (provider outreach, escalations) Ability to work with high-volume operations and SLAs

Experience & Qualification Experience: 3–6+ years in Provider Credentialing/Recredentialing (BPO/US Healthcare) Education: Bachelor’s degree (Healthcare/Admin/Business preferred) KPIs / Performance Metrics Recredentialing TAT adherence PSV accuracy & compliance score Documentation quality / audit pass rate Queue management (aging, backlog reduction) Value Add (for BPO Portfolio / RFP positioning) Ensures regulatory compliance and reduces audit risk Improves provider network accuracy and reliability Minimizes claim denials due to credentialing gaps Enhances provider onboarding continuity and payer alignment

Skills

Provider Credentialing, NPPES, NPDB,



Healthcare Systems

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 Provider Credentialing, NPPES, NPDB, Healthcare Systems

About UST

UST is a global digital transformation solutions provider. For more than 20 years, UST has worked side by side with the world’s best companies to make a real impact through transformation. Powered by technology, inspired by people and led by purpose, UST partners with their clients from design to operation.

With deep domain expertise and a future-proof philosophy, UST embeds innovation and agility into their clients’ organizations. With over 30,000 employees in 30 countries, UST builds for boundless impact—touching billions of lives in the process.

📌 Associate II - HealthPlan (Claim Adjudication) (Chennai)
🏢 UST
📍 Chennai