Handle inbound calls for dental and vision insurance regarding eligibility, benefits, and claims. Act as a liaison between the organization and member services to resolve provider and member issues.
SKYGEN
8 Remote Job Openings at SKYGEN
Serve as a subject matter expert and team lead providing training, mentoring, and operational support for dental authorizations. Act as a liaison for client implementations and drive process improvements to ensure organizational success.
Ensure accurate and timely payment of claims to providers while resolving complex payment issues through research and analysis. Develop auditing procedures to maintain data controls and identify potential claim audit exposures.
Act as the primary liaison between clients and internal teams to ensure business needs are met and contractual obligations are fulfilled. Manage day-to-day requests, resolve account issues, and identify opportunities for business growth and process improvement.
The role involves identifying and recruiting healthcare providers to ensure contractual network requirements are met. Daily tasks include performing market analysis, conducting negotiations, and maintaining provider relationships via phone outreach.
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.
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.
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.
