Provider Data Ops Lead - Quality & Delivery

UST; Taguig; On-site; PHP 1,800,000 - 2,800,000; Full time

Job summary

UST is seeking a Providers Data Management Team Lead to oversee end-to-end provider data maintenance within a BPM environment. You will manage outreach verification, credentialing updates, and PIMS claim support, ensuring accurate records, governance, and adherence to SLAs.

The role requires strong leadership, process discipline, and collaboration with cross-functional teams to drive continuous improvement in provider data workflows and service delivery.

Qualifications

• Requires a Bachelor’s degree in Healthcare Administration, Business, Life Sciences, or related field.
• 7+ years in US healthcare payer provider data management, credentialing, or provider operations.
• Minimum 2+ years in a Team Lead, SME, or supervisory capacity.

Responsibilities

• Own daily PDM delivery across outreach verification, returned mail, credentialing record updates, and PIMS claim support.
• Manage work allocation, queue balancing, inventory aging, productivity, and staffing coverage.
• Coordinate provider outreach by email or telephone when verification is required.
• Oversee resolution of PIMS claims with missing group or practitioner data to support claims processing.
• Lead calibration, defect review, root cause analysis, corrective action, and defect prevention activities.

Skills

People leadership

Stakeholder communication

BPM operations

SLA management

Data governance

Root cause analysis

Education

Bachelor's degree in Healthcare Administration or related field

Tools

PIMS system

Credentialing software

Job description

UST is seeking a Providers Data Management Team Lead to oversee end-to-end provider data maintenance within a BPM environment. You will manage outreach verification, credentialing updates, and PIMS claim support, ensuring accurate records, governance, and adherence to SLAs.

The role requires strong leadership, process discipline, and collaboration with cross-functional teams to drive continuous improvement in provider data workflows and service delivery.