SKYGEN USA

Title: Contact Center Implementation Specialist Location: United States, Remote Department: Professional What are important things that YOU need to know about this role? - Experience: This role requires 3+ years of experience working with IVR systems, CX platforms (NICE CXone preferred), and project-based work involving telephony or contact center technology. Strong analytical and problem-solving skills are key. - Work Location & Schedule: This position offers permanent remote work.Typical work hours are Monday through Friday day shift hours but some weekends or evenings may be required for go-lives or project load. - Role Focus: This is a highly technical, project-based role supporting contact center technology implementations, enhancements, and ongoing optimization within a contact center environment. - Tools & Environment: You’ll regularly work with IVR systems (NICE CXone experience preferred but not required), BI/reporting tools (Power BI), APIs, and workflow documentation tools (Visio/Lucidchart). - Collaboration: This role partners closely with IT, developers, telecom, and leadership teams—strong communication and stakeholder management is critical. What will YOU be doing for us? Responsible for Contact Center new client/market IVR (interactive voice response) technology implementations, capturing project requirements and tracking of efforts. Ensure day to day functionality is working as designed, trouble-shoot issues and respond to a variety of internal and external inquiries. Utilize BI and NICE CXone reports to run analytics with an emphasis on identification of opportunities to optimize the IVR platform. Provide reports to management on IVR utilization. Primary resource for managing department testing of various CXone platform tools. What will YOU be working on every day? - Responsible for managing day-to-day IVR functionality - Handling any troubleshooting for technical issue reports that come out regarding the IVR, NICE systems, etc. - Take initiative to start using SD+ to track all IVR related issues and manage these cases in that platform - Co-host weekly NICE meetings with the Call Center Leadership team, keeping them up to date on project updates, and gathering requirements needed for different projects, such as IVR implementations - Maintaining documentation for the IVR, such as call flows by client, ensuring all IVR prompt recordings are organized, etc. - IVR implementations - Act as the liaison between SKYGEN and external clients to facilitate discussions on IVR build information during new implementations including requirements gathering. - Enter requirements details into the Workflow Variables Module that would set up the IVR for new clients. - Make changes in Workflow Variables Module as necessary for existing IVR set-ups to ensure we are meeting client requests and compliance requirements - Primary resource to test all new IVR flows (i.e., for new features, API’s etc.) in development prior to changes being deployed into production. This includes development of test scenarios, maintenance of test plans, providing appropriate feedback, documenting test results and developing respective documentation. - Coordinate with IT, the Telecommunication’s Administrator and Internal Developers on all IVR and telecomm related projects. - IVR Reporting - Utilize BI and NICE CXone reports to run analytics with an emphasis on trending and identifying areas of improvement to increase IVR self-service utilization. - Maintaining IVR reporting to ensure all information is being captured - Sending out frequent updates to leadership teams regarding containment rates, agent opt-outs, and other metrics deemed necessary for IVR monitoring - Completing audits of the IVR reporting through test calls into the production environment to ensure accurate reporting and advising of any gaps we see that need to be fixed. This would include Client related audits (i.e., Molina MS) - CXone Performance Management - Maintaining day-to-day items needed in the platform (i.e., Gamification adjustments, accuracy of dashboard metrics, etc.) - Gamification Marketplace Management - Assist supervisors in creating games, running campaigns around the games to ensure agent engagement - Investigate Rules Engine and how we can use this as an organization to reward performance based on agent rate and rank (potentially even supervisors as well) - Other project work - Assisting in any projects requiring documentation, notes, follow up, etc. - Assisting in any solutions building, when needed. What qualifications do YOU need to have to be GOOD candidate? - Required Level of Education, Licenses, and/or Certificates - Bachelor’s degree or combination of education and work experience equivalent. - Required Level of Experience - 3 or more years in IVR and CX platform project management, development and telephony projects - Required Knowledge, Skills, and Abilities - Excellent verbal and written communication skills. - Excellent independent problem-solving skills to allow for the correct diagnosis of a problem along with potential solutions for resolution. - Ability to think analytically and make effective decisions quickly. - Ability to effectively listen and respond to internal and external customers’ needs. - Ability to ask critical questions to assess needs and requirements. - Ability to successfully meet timelines for project plans and manage time effectively. - Strong technical workflow documentation ability. - Ability to utilize resources to solve problems independently. - Ability to build and maintain work relationships and contacts needed to effectively address issues and obstacles - Ability to make appropriate decisions when faced with conflicting deadlines or needs. - Advanced user in MS Office products (i.e., Excel, Visio or Lucidchart, PowerPoint) - Experience using business analytics tools such as Power BI - Working knowledge of API (Application Programming Interface) - Ability to analyze statistical data What qualifications do YOU need to have to be a GREAT candidate? - Preferred Knowledge, Skills, and Abilities - Prior knowledge working in health or dental insurance environment The salary range and midpoint 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. Compensation Range: $76,171 - $114,257 Compensation Midpoint: $ 95,214

Title: Authorization Support Representative III Location: United States Job Description: Important things YOU should know: - Schedule: Monday – Friday - 8:00am -5:00pm CST - Holiday/weekend coverage required on a rotational basis - Fully Remote Role - Familiarity with SQL is preferred What will YOU be doing for us? Responsible for complex, non-routine administrative functions within the Authorizations Department. This position does not conduct any clinical reviews or initial clinical screenings. What is in it for YOU? - Career growth in an inclusive culture - Paid training - Health benefits - 401 (k) What will YOU be working on? - Ability to perform all Authorization Support Representative duties - Attend meetings with internal and external customers as subject matter experts - Respond to complex, escalated questions from internal and external customers in a thorough and timely manner utilizing communication that is easily understood by others. - Review monthly and quarterly reports for accuracy as assigned - Enter new authorization schedules, guidelines and denial reasons into company systems to ensure successful implementation of new clients. - Monitor quality of outreaches by ASR’s - Monitor inventory management - Utilize resources available to assess issues (set up, system, etc.) follow through to resolution and root cause analysis. - Assist/lead training of new processes and new team members - Assist in delegation of daily market assignments due to volume fluctuation as needed - Additional Responsibilities: - Identify trends related to provider submissions of dental services and refer on to internal resources for appropriate research and follow through to resolution. - Coordinate/participate in testing for new processes and system upgrades - Act as liaison for department during implementation of new clients by attending cross functional meetings, understanding deliverables for department, communicating appropriately to team members, and ensuring completion of deliverables timely and accurately. What qualifications do YOU need to have to be a GOOD candidate? - Required Level of Education, Licenses, and/or Certificates - High school diploma or equivalent - Required Level of Experience - Minimum of one year Authorizations Support Representative or equivalent work experience - Required Knowledge, Skills, and Abilities - Proficient in all Authorization Support Representative duties - 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. - Proficient computer skills What qualifications do YOU need to have to be a GREAT candidate? - Preferred Level of Experience - Understanding of the authorization process, supervisory experience - Preferred Knowledge, Skills, and Abilities - Excellent verbal and written skills - Proficient Knowledge of Enterprise system The salary range and midpoint 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. Compensation Range: $20.65 - $30.98 / $ 42,955 - $64,432 Compensation Midpoint: $25.81 / $53,694 About Us 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. Job Info - Job Identification3277 - Job CategoryClerical - Job ScheduleFull time - Locations United States(Remote) - Pay Range$20.65 - $30.98

Title: Provider Relations Representative I Location: United States Job Description: What are important things that YOU need to know about this role? - Experience Required: 1-2 years of experience in customer support, provider relations, or a similar role resolving complex or escalated issues. Experience working with healthcare providers, insurance/claims, or high-touch client environments is a strong plus. Ideal candidates are confident communicators who can navigate challenging conversations, build relationships, and problem-solve across teams - Work Location: Enjoy the flexibility of working from wherever you do your best work—this is a permanent remote opportunity that empowers you to stay connected, productive, and supported from day one. - Hours: Flexible, Monday through Friday Day Shift Hours What will YOU be doing for us? Manage provider experience and relationships once the contracting and credentialing processes are completed. Deliver outreach and education to newly credentialed providers regarding best practices to ensure success in working with Skygen as they enter the network as well as resolutions to common issues and questions. Deliver ongoing provider outreach and education to participating network providers and collect feedback on their experience. Handle routine to moderate complexity provider issues including areas such as escalated claim resolution, potential record discrepancies, provider submission errors, single case agreements and electronic set up. Assist in maintaining adequate provider networks through outreach activities related to credentialing and recredentialing. Observe provider experience trends and make suggestions for improving the overall provider experience program. What will YOU be working on every day? - Conduct timely outreach to newly credentialed provider offices and review best practices, frequently asked questions and common issues - Conduct proactive outreach to existing provider offices to collect feedback, identify issues and provide education - Participate in outreach campaigns designed to change provider behavior in area of claim and authorization submissions and electronic relationships - Modify provider records in the system and observe discrepancies in information received and entered. Request clarification or advise Provider Data Management Team Lead/Manager of issues related to data. - Utilize the Provider-related modules in the Enterprise System to research claim, reimbursement and utilization questions. - Complete follow ups, OnTime tickets, and emails according to the department expectations and SLAs - Work with internal departments to produce, maintain, and deliver provider training references and materials. - Work with internal departments to resolve simple to moderately complex outstanding follow ups and OnTime tickets generated from clients, providers and internal sources - Resolve member access to care issues by researching providers and arranging letter of agreement with out of network providers - Using automated systems, maintain updated records on client and Skygen owned provider networks by verifying accuracy and handling any exceptions or issues - Act as a liaison between providers and Client Services to resolve escalated contracting and fee issues for client and Skygen owned provider networks. - Act as a liaison between providers and Dental Reimbursement to resolve any claim inquiry related issues in escalated situations. - Work with internal departments to resolve provider complaints and escalations including state level complaints. - Assist Client Services in researching and resolving client inquiries that involve in depth knowledge of plan or market information. - Based on interactions with provider offices, offer suggestions for improving the overall provider experience What qualifications do YOU need to have to be GOOD candidate? - Required Level of Education, Licenses, and/or Certificates - High school diploma or equivalent - Required Level of Experience - 1 -2 years of prior related experience in resolving escalated and challenging customer issues (i.e. collections, retail management, or senior customer service based roles). - Required Knowledge, Skills, and Abilities - Intermediate knowledge of Microsoft Office products including Word, Excel, and Outlook - Excellent communication written and verbal communication skills - Ability to communicate effectively with a variety of communication styles - Strong analytical skills - Ability to effectively listen and respond to internal and external customer needs - Ability to resolve routine to moderately complex problems - Ability to adapt to changing priorities - Ability to successfully work cross-functionally to resolve problems - High degree of accuracy - Good problem solving and decision making skills - Ability to manage through difficult conversations What qualifications do YOU need to have to be a GREAT candidate? - Preferred Level of Education, License, and/or Certificates - 2 year degree/Bachelor’s Degree - Experience in working with healthcare providers helpful - Preferred Level of Experience - 1-3 years in a Provider Relations or Senior Customer Support role - Preferred Knowledge, Skills, and Abilities - Knowledge of standard dental, medical and/or therapy terminology - Knowledge of internal software The salary range and midpoint 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. Compensation Range: $16.51 – $24.76 per hour ($34,336-$51,504/yr) Compensation Midpoint: $20.63 per hour ($42,920/yr)