PDM Team Lead – Business Process Management (BPM)

Position

PDM Team Lead – Business Process Management (BPM)

Experience

7+ years in US healthcare payer provider data management, provider credentialing, or provider operations, including 2+ years in a Team Lead/SME/Supervisory role.

Job Summary

The PDM Team Lead will be responsible for the end-to-end operational management of Provider Data Management (PDM) services within a BPM environment. The role will lead provider outreach, returned mail, credentialing record updates, and PIMS claim support while ensuring data accuracy, quality, productivity, SLA adherence, compliance, and process governance.

Key Responsibilities

Operations Management

• Manage daily PDM operations across provider outreach, returned mail, credentialing updates, and PIMS claim support.
• Manage work allocation, queue balancing, inventory aging, productivity, and staffing.
• Ensure provider data requests are accurately reviewed, validated, documented, and completed.
• Monitor operational KPIs, productivity, quality, and SLA performance.

Provider Data & Escalation Management

• Act as the first escalation point for complex provider data issues and workflow exceptions.
• Guide the team on provider demographics, specialties, affiliations, practice locations, addresses, credentialing, and claims-related updates.
• Coordinate provider verification through email and telephone outreach.
• Support resolution of PIMS claims involving missing provider/group information.

Quality & Compliance

• Ensure first-time-right processing and provider data validation.
• Lead calibration, defect analysis, RCA, corrective actions, and defect prevention.
• Maintain supporting documentation and evidence for audit readiness.
• Monitor risks related to expirable credentials, returned mail, unresolved verification, and compliance gaps.
• Drive continuous process improvement.

Stakeholder Management & Reporting

• Coordinate with Client Operations, SMEs, QA, Credentialing, Claims, Compliance, and Training teams.
• Prepare weekly operational reports covering production, inventory, issues, risks, and support requirements.
• Support monthly governance and service performance reviews.
• Recommend process, documentation, and automation improvements.

People Leadership

• Lead, coach, and mentor PDM and QA analysts.
• Support new-hire training, cross-training, refresher training, and knowledge transfer.
• Ensure consistent process adherence across high-volume workflows.
• Drive employee engagement, capability development, and performance excellence.

Mandatory Skills

• US Healthcare Payer Provider Data Management
• Provider Credentialing
• Provider Outreach & Verification
• Returned Mail Processing
• PIMS Claims Support
• Provider Demographics, NPI, Specialties & Affiliations
• CAQH
• NPDB
• OIG
• SLA & BPM Operations
• Quality Management & RCA
• Inventory Management
• Team Leadership & Escalation Management
• Microsoft Excel

Preferred Skills

• NPPES
• State Licensing Sources
• Provider Information Management Systems
• Payer Administration Systems
• Process Improvement / Automation
• High-volume Healthcare BPM Operations

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Life Sciences, or related discipline.
• 7+ years of relevant US healthcare experience.
• 2+ years in a Team Lead, SME, or supervisory capacity.
• Experience working in SLA-driven, high-volume BPM operations.