SKYGEN

Role Description - Seeking strong work ethic and hard workers who are willing to learn. - Success in this position depends on your ability to think independently, evaluate information critically, and adapt processes when needed. - Remote: Work from almost anywhere in the US with a 100% remote setup. - Schedule: Monday to Friday, with typical day shift hours from 8:00 AM to 5:00 PM CST. - Holiday Coverage: Some flexibility could be needed for holiday coverage depending on business needs. Ensure accurate and timely payment of claims to providers. Utilize research and knowledge of coverage and benefits to ensure resolution to more difficult claim payment issues. - Submit accurate and timely payments to providers, keeping within contractual service level agreements for each market. - Develop and maintain controls over the proprietary processed data and systems set up through developing and implementing auditing procedures, and identifying potential claim audit exposures. - Interpret and understand coverage and benefit limitations by having a comprehensive understanding of benefits and state requirements for multiple markets. - Assure that claims are paid within the expected time frames by monitoring inventory control and working with team members and appropriate resources in other areas to resolve issues related to claims entry. - Identify trends and suggest and develop efficiencies in the review of edit reports and other documentation by reviewing procedures and making appropriate suggestions and adjustments to procedures. - Resolve complex claim payment inquiries by analyzing patient activity and related documentation (including enrollment, claims, and authorizations) and determine appropriate action to be taken. - Resolve complex client issues that may require research, analysis and working with management. - Complete requests for claims review and/or reprocess within internal guideline turnaround times. Qualifications - High school diploma or equivalent - 2 years of prior job related experience (Dental Assistant, Dental/Medical Office Manager, Dental/Medical front office, or health/dental insurance, including managed care operations, accounts receivable and or billing) - Knowledge of health or dental procedures coding and terminology. - Basic knowledge of Microsoft software (Outlook, Excel and Word). - Exceptional written and verbal communication skills. Requirements - Bachelor’s Degree in a related field Benefits The salary range is listed below for your reference. Please keep in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration when determining placement within the range.

Role Description As an Authorizations Support Representative IV, you'll do more than process authorizations—you'll be a trusted advisor, trainer, and operational expert. This role offers the opportunity to lead cross-functional initiatives, support client implementations, mentor team members, solve complex challenges, and drive process improvements that directly impact organizational success. If you're passionate about continuous improvement, collaboration, and sharing your expertise with others, this is an opportunity to make a lasting impact. - Become a trusted expert who drives solutions, supports critical business operations, and serves as a key resource across the organization. - Share your expertise by training and mentoring team members, helping others succeed while shaping operational excellence. - Work from almost anywhere in the US with a 100% remote setup. - Standard Monday through Friday schedule typically 8 am – 5 pm CST, with opportunities to support client audits/escalations before or after normal business hours and/or on the weekend occasionally. - Provide training departmental employees on processes, systems, and applicable client information to ensure successful operations. - Inform Chief Dental Officer and/or designee of compliance results. Provide assistance and training to new and current dental consultants regarding system capabilities and requirements. Ensure consultants have all necessary resources (e.g. - clinical criteria documents, etc.) to complete the job. - Act as liaison for the team during implementation of new clients by attending cross functional meetings, understanding deliverables for department, communicating appropriately to team members, and ensuring completion of deliverables are timely and accurately. - Act as a subject matter expert on behalf of the team. Triaging requests, responding to questions and escalations from internal and external customers in a thorough and timely manner, resolving matters that may fall outside of the established workflows and serving as the main point of contact for live and desktop audits. - Assist manager and supervisor with projects related to staffing, time studies, process improvements and workflows. - Work collaboratively with manager and supervisor to identify staff quality trends that require additional training or documentation updates. - Utilize resources available to assess issues (set up, system, etc.) and locate appropriate resolution. - Update existing resources available to maintain current knowledge and understanding of dental plans coverage provided and departmental processes. - Regularly attend and participate in client and internal meetings as a representative of the team. - Review client reports and serve as the subject matter expert for accuracy. - Maintain accurate and detailed notes of work performed in the company system, as needed. - Work with the team to ensure process documents, resource tools and policies and procedures are accurate and up to date. Qualifications - High school diploma or equivalent. - 3 - 5 years of experience in a clinical dental role or other similar related experience. - Knowledge of dental procedures, terminology and codes. - Excellent organizational skills to ensure required deadlines are met. - Excellent problem solving skills to allow for the correct diagnosis of a problem along with potential solutions for resolution. - Basic computer skills. - Ability to work effectively with various personalities and work styles. - Good verbal and written communication skills. Requirements - Knowledge of Enterprise system. - Authorization processing experience. - Project coordination. Benefits The salary range is listed below for your reference. Please keep in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration when determining placement within the range.

Role Description This is a permanently remote position. Full-time, Monday through Friday during daytime hours. Utilize effective techniques to identify prospects and recruit providers to ensure contractual requirements are met. - Run and create geographic access reports with assistance - Perform market analysis on new markets including identifying key providers needed to service members with assistance - Develop and maintain complete understanding of contract and network requirements - Ability to navigate proprietary software applications - Perform prospecting calls to new and existing providers to discuss the benefits of joining our networks and providing education about our practices and reimbursement levels - Conduct negotiations with providers to build and maintain a provider network - Conduct negotiations with key providers including large groups and dental schools with assistance - Develop and maintain provider relationships by interacting directly with the provider and serving as the main point of contact for the provider throughout the contracting process - Ensure provider compliance with contracting process - Utilize relationships with existing providers to generate referrals to additional providers in the network - Identify network access and deficiencies and develop recruitment and contracting strategies - Maintain understanding of the web portal in order to effectively explain its functionality to providers - Perform outreach calls in assist in resolution of resolve specific access to care issues for members Qualifications - Bachelor’s Degree in business or related field or equivalent years of experience - 1 year of experience relating to provider relations, contracting, or sales/negotiation - Knowledge of Microsoft programs (Word, Excel, and Outlook) - Detail oriented - Excellent oral and written communication skills - Ability to successfully meet timelines for project plans - Ability to build relationships effectively over the phone Requirements - Knowledge of contract terminology - Understanding of reimbursement methods - Knowledge of dental, medical, physical therapy and vision products and terminology Benefits - Compensation Range: $20.32 - $30.48/hr - Compensation Midpoint: $25.40/hr Company Description SKYGEN is the trusted partner for specialty benefits payers and government agencies responsible for the delivery and administration of dental and vision benefits. Through cutting-edge technology and service solutions, SKYGEN empowers clients to become the most efficient, effective healthcare organizations in the country.

Role Description Take an active role in the financial performance of the company by using data analysis and analytics to optimize financial reporting and processes to ensure accurate, timely and enhanced data and reporting for the organization. Daily Responsibilities - Financial Reporting & Analysis: - Prepare, analyze, and interpret monthly, quarterly, and annual TPA financial reports. - Support Finance and Operations by completing financial analysis and TPA reporting. - Develop and maintain dashboards, external reporting deliverables, and management reporting packages. - Ensure accuracy and consistency of financial data across systems and reports. - Data & Systems: - Use SQL to extract, transform, and analyze data from multiple sources. - Build and maintain SQL queries, views, and datasets to support reporting and ad‑hoc analysis. - Collaborate with IT, data teams, and business partners to improve data quality and streamline reporting workflows. - Assist in system enhancements, testing, and implementation of new financial tools or modules. - Process Improvement: - Identify opportunities to automate manual processes and improve reporting efficiency. - Document processes, controls, and reporting standards. - Support internal and external audit requests with accurate, well‑organized data. Qualifications - Bachelor’s degree in Accounting, Finance, Data Analytics or a related field. - 3-5 years experience with financial reporting, general ledger systems, and finance operations. - Strong SQL proficiency (writing queries, joining tables, troubleshooting data issues). - Solid understanding of accounting principles. - Advanced Excel skills (pivot tables, lookups, modeling). - Strong analytical mindset and attention to detail. Requirements - Experience with BI tools (Power BI, Tableau, Looker, etc.). - Familiarity with ERP systems (SAP and Oracle). - Experience working with large datasets or data warehouses. - CPA, CMA, or progress toward certification. Compensation - Compensation Range: $85,202 - $127,802 - Compensation Midpoint: $106,502 Company Description SKYGEN is the trusted partner for specialty benefits payers and government agencies responsible for the delivery and administration of dental and vision benefits. Through cutting-edge technology and service solutions, SKYGEN empowers clients to become the most efficient, effective healthcare organizations in the country.

Role Description This is a fully remote opportunity, giving you the flexibility to lead and support a credentialing team from anywhere. We’re looking for someone who can serve as a subject matter expert in commercial credentialing, so strong experience with commercial insurance is essential (dental experience is a plus). This role requires proven leadership experience, with 3–5 years in a credentialing management capacity, including developing teams and driving performance. - Oversee the Credentialing department to ensure the providers are credentialed in a timely and accurate manner. - Resolve complex issues and work with staff to provide feedback and training to ensure Credentialing processes are completed timely and accurately. - Develop and implement departmental procedures, quality measures, set goals and objectives to ensure effective and compliant workflow. - Foster an environment of continuous improvement through process and systematic efficiencies. - Work in conjunction with Human Resources to evaluate viable candidates under consideration for hire. - Develop and motivate staff; initiate and communicate a variety of personnel actions including employment, terminations, performance reviews, salary reviews, disciplinary actions, and development plans. - Provide regular and behaviorally specific feedback to increase performance levels. - Oversee staff timecard and PTO requests to ensure timely and accurate reporting. - Develop and maintain standard procedures for the Credentialing department. - Assist in resolving complaints and issues for clients, providers, and internal staff. - Develop and maintain training documents to ensure accuracy and thoroughness. - Work effectively and collaboratively with peers and other internal resources in diagnosing and resolving issues. - Identify and report credentialing issues to appropriate departments and leadership. - Assist in the ongoing evaluation of policies and procedures and assist in development and implementation of new efficiencies based on assessments. - Work with Director of Provider Experience to identify, develop and implement best practices. - Serve as subject matter expert for credentialing requirements, including NCQA standards, federal and state regulatory guidelines, and accreditation-related expectations. - Provide leadership and guidance on credentialing policies, procedures, and operational practices. - Monitor credentialing performance for large clients and drive corrective actions. - Identify opportunities to improve consistency, reporting, and operational performance across large client credentialing processes. - Act as an expert in area of credentialing and accreditation practices. - Ensure all departmental processes meet organization and industry standards. - Provide regular reporting and status updates to clients and participate in client meetings. - Must comply with registering and creating your own id.me account or using your personal id.me account for identity verification. Qualifications - 2 year/Associate degree in Business or related field. - 3 - 5 years of experience in credentialing management capacity. - Ability to organize and report on large amounts of data. - Ability to organize work appropriately to meet deadlines. - Ability to successfully lead teams. - Demonstrated ability to make appropriate decisions when faced with conflicting deadlines or needs. - Demonstrated use of Microsoft Office products (Word, Excel, PowerPoint). Requirements - 2 year or 4 year degree in Business Administration or similar field (preferred). - Experience with dental, commercial (preferred). - Knowledge of Enterprise System (preferred). Benefits - Compensation Range: $85,284 - $127,926. - Compensation Midpoint: $106,605. Company Description SKYGEN is the trusted partner for specialty benefits payers and government agencies responsible for the delivery and administration of dental and vision benefits. Through cutting-edge technology and service solutions, SKYGEN empowers clients to become the most efficient, effective healthcare organizations in the country.

Role Description - 100% remote role offering flexibility and work-life balance. - Lead and develop a team of 12-15 direct reports, supporting a collaborative, performance-driven culture. - Operate within daytime hours (8:00–4:30 CST), with shared leadership support for off-shift coverage on a rotating schedule. - Hands-on leadership role where you can make an immediate impact and grow your career. Responsible for overseeing the Claims Intake department offering supervision and leadership to ensure day-to-day business needs are completed accurately and timely and in accordance with client and regulatory requirements. What will YOU be working on? - Act as a subject matter expert for the Claims Intake team; answering questions to internal and external contacts and resolving matters that may fall outside of the established workflows. - Assist with escalated issues on behalf of Claims Intake staff. Work with internal staff as needed to ensure resolution of escalated issues. - Assist as a point of contact for system upgrades for the team. Coordinates testing with the team, and other operational departments and reports issues appropriately for resolution. - Oversee staff timecard and PTO requests to ensure timely and accurate reporting, and adequate coverage to meet client Service Level Agreements. - Works within Operational budget requirements. - Manage the daily work plan assignments and monitor work volumes to ensure all submissions and/or special handling requests are completed within client specific timeframes. - Provide support to the Claims Intake team. - Maintain and monitor individual/team performance to ensure compliance with department guidelines, standards and established expectations. - Evaluate employee and team performance to identify training and development needs. - Collaborate with Manager and Support Specialist to develop, maintain and facilitate all training and materials to ensure staff is appropriately trained to successfully perform their roles. - Proactively communicate updates and changes to client requirements and reference materials in a timely manner. - Facilitate quick and accurate issue resolution by developing and maintaining collaborative working relationships with internal departments. - Proactively identify potential issues and communicate to management. Ability to critically think about how workflow decisions will impact department along with downstream impacts. - Partner with Manager in implementing process improvements. Work closely with management team in identifying process, tool and efficiency improvements. - Assist in the development of workflow documentation and policies and procedures. - Assist in the ongoing evaluation of policies and procedures and assist in development and implementation of new efficiencies based on assessments. - Participate in internal and external audits and provide thorough documentation and research as needed. - Work with Manager to identify, develop and implement best practices to ensure improved efficiency, cost effectiveness, and that contractual requirements are met and/or exceeded. Qualifications - High school diploma or equivalent. - 2-4 years of prior job-related experience in a leadership role. - Excellent written and communication skills. - Excellent customer service skills including active listening and the ability to diffuse difficult situations. - Ability to use effective judgment and prior experience to troubleshoot common issues. - Ability to organize work appropriately to meet deadlines. - Ability to utilize resources to solve problems independently. - Excellent time management skills and can demonstrate ability to make appropriate decisions when faced with conflicting deadlines or needs. - Intermediate knowledge of Microsoft Office products (Word, Excel, and PowerPoint). Requirements - Associate or bachelor’s degree. - Experience working in a dental or medical environment. - Knowledge of Enterprise System. - Advanced knowledge of Microsoft Office Suite (Word, Excel, PowerPoint).

Role Description Important things YOU should know: - Training & Production Schedule: Monday - Friday, 8:00am - 4:30pm CST - Please know hours of operation are 8:00am – 6:00pm CST so shift could flex based on business need. - Fully Remote - Customer Service in Dental or Health Insurance experience a plus! What will YOU be doing for us? - Increase member, provider and client use of our web based solutions for claims submission, payments, and authorizations. What will YOU be working on? - Provide education to callers on the benefits of utilizing the member and provider insurance portals. - Service dental, medical, vision and physical therapy members and providers using the member and provider portals offered by SKYGEN USA. - Provide feedback to multiple internal departments regarding issues found on the member and provider portals. - Ensure all calls are answered according to company and client guidelines. - Accurately document call information and resolution in internal systems while engaging with members and providers. - Properly identify potential issues that are not easily resolved and escalate appropriately to Manager. - Perform outbound calling projects as directed. Additional Responsibilities: - Utilize multiple modules in the Enterprise System to research portal questions. - Work with internal departments to produce, maintain, and deliver portal training references and materials. - Work with call center to resolve outstanding follow ups generated from incoming calls. - Using automated systems, maintain updated data on portals by verifying accuracy and handling any exceptions or issues. - Act as a liaison between portal users and clients to resolve escalated issues. - Provide recommendations on system enhancements and process improvements to management. - Assist department with administrative tasks and additional duties as needed. Qualifications - High school diploma/GED required - 1 year of customer service experience (Call Center, Provider Relations). - Intermediate knowledge of Microsoft programs (Word, Excel, and email) - Excellent attention to detail - Excellent oral and written communication skills - Ability to successfully meet timelines for project plans - Strong navigation skills and the ability to multi-task Requirements - Associates degree/2 year degree in related field (preferred) - 1-3 years of customer service experience (Call Center, Provider Relations) (preferred) - Knowledge of contract terminology (preferred) - Understanding of reimbursement methods (preferred) - Knowledge of dental, medical, physical therapy and vision products and terminology (preferred)

Role Description This position is eligible for fully permanent remote work, allowing you to work from anywhere. - Schedule: Monday to Friday, with typical day shift hours from 8:00 AM to 5:00 PM CST. - Possible Weekend or Extended Hours: There may be occasional weekend or extended hours to meet contract deadlines or urgent requirements. - Holiday Coverage: Some flexibility will be needed for holiday coverage depending on business needs. What will YOU be doing for us? - Review, analyze, and process complaints and appeals regarding dental and vision services. - Communicate with both internal and external entities to resolve complex payment disputes, quality of care issues, and requests for appeal regarding the denial of healthcare and/or dental services. What will YOU be working on every day? - Analyze, triage, investigate, research, and process standard and escalated appeals, complaints or state complaints from members, providers, health plans, and state agencies. - Communicate effectively with internal staff, members, and providers in the investigation and resolution of various appeals, complaints, and grievances. - Accurate data entry and documentation of all appeal, complaint, and grievance activity for reporting and trending analysis. - Accurately create formal correspondence to confirm receipt and provide resolution for member and provider complaints and appeal requests. - Analyze and process all inbound mail scans and enterprise follow-up communication to the Appeals department. - Maintain strict compliance by utilizing Open Inventory Report, DASH, and regulatory standards for appeal and grievance turnaround times and documentation requirements. - Immediately notify a member of department leadership or quality auditor of potential compliance risk. - Participate in client audits and SKYGEN reaccreditation audits and interviews. - Utilize all job aids, work instructions, and step actions available to maintain current knowledge and understanding of existing processes based on delegated responsibilities. - Participate in job aid creation or updates in collaboration with ACG III and IV. - Utilize assigned team-specific chats while communicating effectively and in a professional manner as it relates to work assignments. Qualifications - Required Level of Education, Licenses, and/or Certificates: High school diploma or equivalent required. - Required Level of Experience: - 1 plus years of job-related experience (such as billing, problem solving, researching, etc.). - 1 plus years of job-related experience interacting with customers and clients. - Required Knowledge, Skills, and Abilities: - Knowledge of general computer software; to include competencies in Outlook, Excel, and MS Word. - Ability to work overtime as needed. - Ability to communicate effectively and engage in a remote environment. - Ability to work through challenging issues with others in a professional manner. - Accurate inventory management including data entry, time management, and typing skills. - Strong verbal and written communication skills. - Ability to draft letters with strong attention to accuracy and grammar. Requirements - Preferred Level of Experience: - Previous experience processing appeals or complaints in a healthcare setting. - 2 years of prior job-related experience (Dental Assistant, Dental Office Manager, Dental front office, or health/dental insurance, including managed care operations, accounts receivable, and/or billing). - Preferred Knowledge, Skills, and Abilities: - Ability to resolve complex problems. - Ability to work autonomously. - Experience working in a dental environment. - Ability to successfully have crucial conversations to resolve assigned appeals or complaints. Benefits - Compensation Range: $17.55/hr – $26.34/hr - Compensation Midpoint: $21.94/hr

Role Description Our Customer Service Representatives must have strong problem-solving skills, coupled with the natural ability to provide empathy for the customer – always taking the time to patiently listen and understand their questions to help find a viable solution, while providing them with a memorable customer experience. - Servicing our Dental and Vision inbound callers with information regarding their eligibility, benefit coverage, authorizations, claims, and assisting them with locating a provider in their area. - Utilize knowledge of claim adjustments and resubmission processes to determine appropriate resolution to provider requests. - Provide feedback to Provider Relations staff on high-level claim issues including but not limited to issues with reimbursement schedules or conflicting information to ensure providers receive a prompt resolution. - Support enrollment activities including but not limited to assigning primary care providers, and updating third party insurance information. - Act as liaison between our organization and the client’s Member Services staff to resolve issues such as eligibility and filing appeals and grievances. - Provide updates to providers with questions regarding the status of their credentialing application. - Recognize provider questions that could be handled through the use of the provider web portal and provide education to these callers on the benefits of utilizing the technology available. - Ensure all calls are answered according to company and client guidelines. - Accurately document call information and resolution in our internal systems. - Apply effective diffusion techniques when necessary to ensure our customers feel heard, valued and supported. - Properly identify issues that need to be escalated appropriately to the leadership team. Additional Responsibilities: - Provide recommendations on system enhancements and process improvements to management. - Keep our Provider Relations team updated with provider manual discrepancies, change in locations or any other provider related issues. - Participate in departmental projects when applicable. Qualifications - High school diploma or equivalent. - 1+ years of job related customer service experience within industries such as healthcare, call center, banking or retail. - Basic knowledge of Microsoft Office products including but not limited to Word, Excel, and Outlook. - Ability to work occasional overtime as needed. - Excellent listening and communication skills. - Superior customer service skills including the natural ability to provide empathy. - Strong data entry/typing skills. - Strong navigation skills and the ability to multi-task. - Excellent attention to detail. - Critical thinking skills to quickly analyze and clearly understand a specific request or customer need and then leverage knowledge and resources to provide the appropriate solutions. Requirements - 1+ years of job related customer service experience within the dental, vision or medical industry. - Previous experience working in a virtual environment. - Understanding of dental, vision and/or medical insurance terminology. Benefits - Fully remote opportunity. - Training schedule: 8:00am - 4:30pm Monday – Friday CST for the 1st 12 weeks. - Work schedule (after training): Multiple opportunities available with ranging start times from 7:00am CST to 10:30am CST Mon - Fri. - Hours of operation: 7:00am - 10:00pm CST Monday - Friday so shift could flex based on business need. - $2.00/hour differential on Mon/Tues. - Occasional evenings, weekends and holidays possible during Annual Medicare Open Enrollment: 10/1 - 3/31. - Exceptional professional growth in a fun rewarding environment.

Role Description You will have the opportunity to accurately and efficiently input data from insurance claim and/or authorization requests submitted by health care providers or members into the database system. - Enter data from insurance claim, authorization or member reimbursement requests expediently and efficiently to meet client turnaround times. - Log unclean submissions so rejection letters are generated back to the servicing provider and a record is retained within the system. - Ability to perform repetitive tasks with a high degree of accuracy. - Navigate efficiently and effectively through the imaging software to retrieve claims and authorizations for data entry. - Maintain proficiency with data entry guidelines and unique client requirements. - Accurately identify specific document types that require special handling. - Work collaboratively with other team members to ensure that work is completed in accordance with designated turnaround times. - Support additional workflows as needed due to internal or external requirements. - Alert management of potential issues upon identification of discrepancies. - Provide recommendations on process improvements to increase efficiencies as appropriate. - Utilize resources available to maintain current knowledge and understanding of client processing rules. Qualifications - High school diploma or equivalent. - Successfully complete a pre-employment online alphanumeric data entry assessment. - Strong data entry/typing skills. - Excellent attention to detail. - High degree of accuracy. Requirements - 1+ year experience in data entry or transcribing services, preferably related to medical or dental claim submissions. - 1+ year of successful experience working in a remote environment. Benefits - Career growth in an inclusive culture. - Paid training. - Health benefits. - 401 (k).