Serve as a technical lead for TPA clients by managing system configurations and translating business requirements into functional specifications. Lead client implementations, provide technical support, and generate data reports using SQL.
SKYGEN
9 Remote Job Openings at SKYGEN
Handle inbound calls regarding dental and vision insurance eligibility, benefits, and claims while assisting providers with credentialing and portal usage. Act as a liaison between the organization and member services to resolve eligibility issues and process appeals.
The role focuses on optimizing financial reporting and processes through data analysis to ensure accurate and timely organizational reporting. Daily tasks include preparing TPA financial reports, maintaining dashboards, and using SQL to extract and transform data.
Responsible for implementing and optimizing IVR technology and CX platforms for new and existing clients. This includes managing technical troubleshooting, creating workflow documentation, and analyzing platform utilization metrics to improve self-service rates.
Oversee the credentialing department to ensure providers are credentialed accurately and timely while serving as a subject matter expert in commercial insurance. Lead and develop staff, implement departmental procedures, and ensure alignment with NCQA and regulatory guidelines.
Provide customer support for dental and vision insurance callers regarding eligibility, benefits, and claims. Act as a liaison between the organization and member services to resolve issues and educate providers on using the web portal.
Customer Care Representatives will service inbound callers regarding their eligibility, benefit coverage, and claims. They will also act as a liaison between the organization and clients to resolve issues and provide updates.
Supervise a team of 15-20 customer care representatives to ensure high service levels and adherence to department guidelines. Responsibilities include coaching staff, managing daily call center operations, and handling escalated customer concerns.
Educate members and providers on using web-based portals for claims, payments, and authorizations. Act as a liaison between users and clients to resolve issues and provide feedback for system enhancements.
