Provider Services Associate II

UST USource; Pateros; On-site; PHP 446,000 - 714,000; Full time

Job summary

UST USource in Metro Manila is seeking a Provider Data Validation Specialist to review and correct healthcare provider information, ensuring accuracy and compliance with SLAs and process guidelines.

You will validate demographics, credentials, network status, and payment details; update records; perform QA checks; and escalate complex cases while collaborating with the team. Night shift onsite role emphasizing data integrity and HIPAA compliance.

Qualifications

• 3+ years of BPM/BPO operations or data processing.
• Experience in US healthcare or health insurance domain.
• Strong attention to detail and accuracy.
• Excellent English verbal and written communication.
• Amenable to work onsite and nightshift.

Responsibilities

• Review provider data such as demographics, credentials, network status, and payment-related details.
• Update and correct provider records per SOPs.
• Complete transactions within SLA, productivity, turnaround time, and quality standards.
• Perform required quality checks to ensure data accuracy.
• Research data discrepancies and escalate complex cases to the appropriate team.
• Maintain accurate records of transactions, corrections, and outcomes.
• Follow HIPAA and data privacy requirements.
• Coordinate with team members and stakeholders for timely issue resolution.

Skills

Data validation

Data correction

SLA metrics

Quality assurance

Issue resolution

Documentation

HIPAA compliance

Collaboration

Night shift

Education

Bachelor's degree

Tools

MS Office

Job description

Responsible for reviewing, validating, and correcting healthcare provider information as part of BPM operations. The role focuses on maintaining accurate provider data, meeting defined quality and productivity targets, and completing assigned activities within established SLAs and process guidelines.

Key Roles and Responsibilities

• Provider Data Validation: Review provider information such as demographics, credentials, network status, and payment-related details and identify discrepancies or incomplete information.
• Data Correction: Update and correct provider records accurately based on defined process guidelines and standard operating procedures.
• Process Execution: Complete assigned transactions within agreed SLA, productivity, turnaround time, and quality standards.
• Quality Assurance: Perform required quality checks to ensure provider information is complete and accurate.
• Issue Resolution: Research data discrepancies, identify recurring issues, and escate complex cases to the appropriate team or supervisor.
• Documentation: Maintain accurate records of transactions, corrections, and outcomes as required by the process.
• Compliance: Follow applicable healthcare data privacy, security, and compliance requirements, including HIPAA.
• Collaboration: Coordinate with team members, leads, and other stakeholders for timely resolution of provider data issues.
• UST Values: Uphold UST values of Integrity, Customer Centricity, Innovation, Collaboration, Excellence, and Respect.

Required Skills and Qualifications

• Experience: 3+ years of experience in BPM/BPO operations or data processing, preferably in the US healthcare or health insurance domain.
• Good understanding of transaction processing, SLA, quality, and productivity metrics.
• Strong attention to detail and accuracy.
• Good analytical and problem-solving skills.
• Working knowledge of MS Office and data processing applications.
• Good verbal and written communication skills in English.
• Ability to work effectively in a team and handle process volumes within defined timelines.
• Amenable to work onsite and nightshift

Education

• Graduate/Degree in any discipline