Jobs at SKYGEN USA

Perform daily and monthly audits of authorization case work to ensure SLA and regulatory compliance. Provide technical and administrative support for authorization processing, run SQL scripts to monitor SLA adherence, troubleshoot system/configuration issues, communicate audit findings, and recommend/implement process controls to resolve quality issues.

Provide administrative support for dental insurance authorizations: review submissions for compliance, contact providers for missing clinical information, enter and modify authorizations, maintain detailed records, assist with audits and internal requests, and respond to internal inquiries following department policies.

Lead and document business requirements, analyze workflows, coordinate stakeholder outreach, testing, and training, identify process improvements, produce operational reports, and communicate status, risks, and solutions.

Serve as subject matter expert for provider contracting and network development: resolve escalations, conduct provider outreach and negotiations, deliver training and maintain knowledge base, perform market and cost analyses, manage contracts and campaigns, mentor junior staff, and support reporting and proprietary systems to ensure network adequacy and provider compliance.