Teams at SKYGEN USA

Recruit and contract providers for the network through outreach, prospecting calls, negotiations, and relationship management. Perform market and geographic access analysis, ensure contract and network compliance, use proprietary software and web portal, and resolve access-to-care issues for members.

Review, investigate, and process dental and vision appeals, complaints, and grievances. Communicate with members, providers, and internal teams to resolve payment disputes and quality-of-care issues. Maintain accurate documentation, meet regulatory turnaround times, participate in audits, and use designated systems and job aids to ensure compliance and reporting.

Serve as technical lead for TPA clients to configure the enterprise system, lead implementations, translate business requirements into system and workflow specifications, liaise with internal teams, provide ongoing technical support and training, produce SQL-based reports, participate in upgrades, and report system defects.