Role: PDM Analyst – BPM

Job Summary

The PDM Analyst will be responsible for reviewing, validating, updating, and maintaining accurate provider information within a US Healthcare BPM environment. The role involves provider data management, outreach verification, returned mail processing, credentialing record updates, and PIMS claims-related provider setup while ensuring compliance with defined quality, productivity, SLA, and turnaround-time requirements.

Multiple location : Bangalore , Trivandrum, Hyderabad, Chennai

Key Responsibilities

Provider Data Management

• Review and process provider update requests.
• Validate and update provider demographics, addresses, specialties, affiliations, and practice locations.
• Maintain accurate provider records and supporting documentation.
• Identify incomplete, inconsistent, or conflicting information and escalate as required.

Provider Outreach & Verification

• Contact providers through email or telephone to verify information.
• Document outreach attempts, responses, and validation outcomes.
• Ensure provider updates are supported by appropriate evidence before closure.

Returned Mail

• Review returned mail cases and validate provider address information.
• Update applicable systems with verified information.
• Escalate unresolved discrepancies or network-access concerns.

Credentialing & Recredentialing

• Review credentialing records and update information as per approved procedures.
• Validate required documentation and identify missing or inconsistent information.
• Support recredentialing activities, primary source verification, and compliance checks as applicable.

PIMS Claims Support

• Review claims pended due to missing group or practitioner information.
• Research and update missing provider information in the designated system.
• Validate provider data to support downstream claims processing.
• Escalate unresolved records appropriately.

Quality & Operations

• Manage assigned inventory and meet productivity, quality, SLA, and TAT requirements.
• Perform self-quality checks and resolve defects.
• Maintain accurate trackers, dashboards, case notes, and status records.
• Support backlog reduction, aging control, audits, and continuous improvement initiatives.

Mandatory Skills

Provider Data Management | Provider Credentialing | CAQH | NPDB | US Healthcare | Claims Management | Provider Operations | BPM/BPO

Preferred Skills

NPPES | OIG | Recredentialing | Provider Outreach | PIMS | Healthcare Payer Operations | Microsoft Excel

Qualifications & Experience

• Bachelor's degree in Healthcare Administration, Business, Life Sciences, or related field preferred.
• 3–6+ years of experience in US Healthcare Provider Data Management, Credentialing, Recredentialing, or Provider Operations.
• Healthcare Payer/BPO/BPM experience preferred.
• Strong attention to detail, documentation, analytical, communication, and problem-solving skills.