What Skygen USA does

SKYGEN USA is a privately held healthcare technology company that provides cloud-native SaaS benefits automation and third-party administration (TPA) services for dental and vision specialty benefits. The company's core technology is the Enterprise System, a proprietary SaaS platform purpose-built for dental and vision administration that enables real-time claims processing, automated eligibility verification, provider credentialing, and integrated analytics. The platform is complemented by the SKYGEN Dental Hub, a connected ecosystem that consolidates payer-provider workflows (credentialing, claims, eligibility, provider directory) into a single interface, plus a Marketplace Connectivity suite of API integrations, member mobile applications, and add-on modules including the Provider Select Suite, Enhanced Benefits Management (EBM) analytics, and the Gold Card Program for prior authorization. SKYGEN serves commercial and government payers, health plans, state Medicaid agencies, Medicare Advantage plans, and Dual Eligible Special Needs Plans (D-SNPs), with operations spanning all 50 U.S. states plus the District of Columbia and Puerto Rico.

The company monetizes through a hybrid SaaS-plus-TPA model: SaaS platform licensing on a subscription basis (priced by member lives and feature modules under multi-year contracts) and TPA services billed via per-member-per-month administrative fees or per-claim processing fees for fully outsourced dental, vision, Medicaid, and Medicare Advantage administration. Additional revenue is generated through analytics and risk management engagements (EBM consulting, fraud/waste/abuse detection) and add-on module licensing (Provider Select Suite, Vision Materials Ordering, Revenue Cycle Management). Go-to-market is anchored in direct enterprise field sales targeting C-suite and VP-level decision-makers at payer organizations, augmented by channel partnerships with benefits brokers and consultants, a TPA-to-SaaS migration offering, and active participation in industry associations (NADP, MSDA, NAVCP) and conferences. SKYGEN serves nearly 50 million member lives on its technology platform and an additional 10 million through outsourced administration, processes approximately 3 million claims per month, and partners with more than 40 government and commercial payer organizations.

Founded in 1996 by Craig Kasten and Greg Borca (who previously co-founded Doral Dental), SKYGEN is led by CEO Steven J. Berryman, supported by a full C-suite including a Chief Technology Officer, Chief Financial Officer, Chief Dental Officer, Chief Information Security Officer, and Chief Client Success Officer. The company maintains HITRUST CSF v11.3.2 and SOC 2 Type II certifications across its Menomonee Falls, Wisconsin headquarters and Mequon, Wisconsin data center, and reinvests approximately 30% of annual revenue into platform enhancement (10-15%) and new capability R&D (20%). The company is founder/management-controlled with no disclosed institutional investors.

Name

Skygen USA

Legal name

SKYGEN USA

Website

https://skygenusa.com

Company type

Private

Founded year

1996

Operating status

Operating

Headcount range

501–1,000 employees

Short description

SKYGEN USA provides cloud-native SaaS benefits automation and third-party administration services for dental and vision specialty benefits, serving commercial payers, government Medicaid/Medicare programs, and providers across all 50 U.S. states via its Enterprise System and Dental Hub platforms.

Ownership category

akta.pro rank

Product category

Dental and Vision Benefits Administration Software

NAICS

Computer Systems Design and Related Services (54151)

SIC

Services-Prepackaged Software (7372)

akta.pro primary industry

Ancillary Benefits TPA (Dental/Vision/Life/Accident/Critical Illness) (HLAEALAN)

akta.pro secondary industries

Dental Benefit Administration (DBA) & ASO/TPA for Dental (HLAEAIAJ), Vision Benefit Administration (VBA) / Vision TPA (ASO) (HLAEAJAI), Medicaid/CHIP Dental & Vision Benefits Administration (FSAIAHAK), Medicare Plan Administration & Third-Party Services (TPA/BPO, Enrollment, Billing) (FSAIAGAI), Compliance, Reporting & Regulatory Administration (ERISA/ACA/No Surprises) (HLAEALAJ)

Keywords

• Dental benefits administration
• Vision benefits automation
• Healthcare claims processing
• Specialty benefits SaaS
• Third-party administration

Headquarters

HQ city

Menomonee Falls

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

Technology or R&D, Personnel, Infrastructure, Operations, Marketing or Sales, Others

Revenue model

1. SaaS Platform Licensing: SKYGEN licenses its proprietary Enterprise System and Dental Hub SaaS platform to dental and vision benefit payers, government agencies, and other TPAs. The platform provides automation for claims processing, eligibility verification, provider data management, and analytics. Pricing is subscription-based with tiered configurations based on member lives administered and feature modules selected.
2. Third-Party Administration (TPA) Services: SKYGEN provides fully outsourced benefits administration services for dental, vision, Medicaid, Medicare Advantage, and D-SNP plans. This includes claims processing, network development and management, utilization review, and member/provider support. Revenue is generated through per-member-per-month (PMPM) administrative fees or per-claim processing fees.
3. Analytics and Risk Management Services: Enhanced Benefits Management (EBM) and Analytics services delivered as consulting engagements or integrated SaaS add-ons. These include fraud, waste & abuse detection, provider performance analytics, benefit plan review, and market analysis. Revenue may be bundled with TPA or SaaS contracts or offered as standalone professional services.
4. Marketplace Connectivity & Add-on Modules: Additional modules including Provider Select Suite, Gold Card Program, Vision Materials Ordering, Revenue Cycle Management, and Integrated Online Eyewear Benefits. These are sold as add-ons to core SaaS or TPA contracts, generating incremental recurring revenue from existing client base.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels8 records

Core offering

SKYGEN USA designs, builds, and licenses a cloud-native SaaS benefits automation platform for dental and vision specialty benefits administration, including the Enterprise System and Dental Hub. The company also delivers third-party administration (TPA) services, processing claims, managing provider networks, and administering dental, vision, Medicaid, Medicare Advantage, and D-SNP programs on behalf of commercial and government payers. Its offerings include add-on modules for analytics, provider performance, member self-service, and vision materials ordering.

Product overview

SKYGEN offers a comprehensive dental and vision benefits management platform combining SaaS automation technology with third-party administration (TPA) services. The core architecture consists of the SaaS Benefits Automation Platform supporting Dental Benefits Automation Software and Vision Benefits Automation Software, complemented by the Dental Hub—a 'virtual town square' connecting payers and providers. Key add-on modules include Provider Select Suite for performance management, API Technology for system connectivity, Member Mobile App and Self-service Portals for member engagement, Network Development & Credentialing and Provider Data Management for network administration, Revenue Cycle Management, Vision Materials Ordering & Management, and Enhanced Benefit Management (EBM) for analytics and risk management. The company also offers TPA services including dental, vision, Medicaid, and Medicare Advantage administration. SKYGEN serves nearly 50 million member lives across all 50 states.

Differentiator

Problem solved

Functional benefit

Brands

• Dental Hub: Connected dental ecosystem platform that streamlines credentialing, claims submission, eligibility checks, and provider directory management for dental practices.
• Provider Select Suite
• Enhanced Benefits Management (EBM)
• Gold Card Program
• Enterprise System
• SKYGEN International Foundation
• SKYGENerosity

Products and services

• Dental Benefits Automation Software

Quantifiable outcome

• Reduced benefit administration costs by over $10 million for a dental benefits administrator client through analytics-driven identification of network gaps, cost-saving opportunities, and fraud/waste/abuse detection
• +2 more outcomes

Named customers7 records

Segments4 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration1 record

AI capability5 records

Feature10 records

Partnerships

13 partnerships are on record, tiered core and minor.

• MetLifecoreStrategic or Co-development Partner · 6 May 2026MetLife teamed up with SKYGEN to transform the dental provider digital experience and credentialing. This partnership enables MetLife to leverage SKYGEN's Dental Hub and Provider Select Suite to modernize provider-facing processes and deliver a more seamless digital experience for dental providers in MetLife's network.
• TeamSmileminorGTM or Marketing Partner · 1 January 2026SKYGEN partners with TeamSmile, a nonprofit organization that provides free dental care to underserved children. SKYGEN employees volunteer at TeamSmile events, and SKYGEN's Chief Dental Officer Dr. Larry Paul serves on TeamSmile's board of directors. SKYGEN supports TeamSmile events including programs with the Pittsburgh Pirates, ShopRite LPGA Classic, and Milwaukee Brewers. The partnership serves both community impact and brand-building purposes.
• Rectangle HealthcoreTechnology or Integration · 1 January 2025SKYGEN partnered with Rectangle Health as part of the PayerSync ecosystem to automate claims payment processing and streamline reimbursements for dental healthcare providers. The integration connects SKYGEN's benefits administration platform with Rectangle Health's payer-to-provider payment solution, which integrates with over 450 payers to reduce payment cycles by an average of 12 days. SKYGEN is listed as one of five strategic ecosystem partners for Rectangle Health's PayerSync platform.
• Clover HealthcoreTechnology or Integration · 1 January 2025Clover Health is a partner in Rectangle Health's PayerSync ecosystem, which includes SKYGEN as a strategic integration partner for dental benefits automation. Through this ecosystem, SKYGEN connects dental providers to Clover's payer network for streamlined claims payment processing.
• ECHO HealthcoreTechnology or Integration · 1 January 2025ECHO Health is a partner in Rectangle Health's PayerSync ecosystem alongside SKYGEN, contributing to automated claims payment processing and streamlined reimbursements for healthcare providers.
• Pacific LifeminorStrategic or Co-development Partner · 1 January 2025SKYGEN partnered with Pacific Life to reaffirm its commitment to excellent customer experience, integrating SKYGEN's specialty benefits administration capabilities into Pacific Life's product offering.
• Albwardy InvestmentsminorGTM or Marketing Partner · 1 January 2025Albwardy Investments is a new partner of SKYGEN International Foundation that provided hotel space in Tanzania for vision screening clinics. Their support enabled screenings to be held as part of the Foundation's mission to bring vision care to underserved communities in East Africa.
• Aflac Dental and VisioncoreStrategic or Co-development Partner · 8 July 2024Aflac's Dental and Vision division partnered with SKYGEN to advance the customer experience journey. SKYGEN's innovative technology delivers the digital experience critical to customer satisfaction for Aflac's supplemental dental and vision insurance offerings.
• SKYGEN International FoundationminorOthersThe SKYGEN International Foundation is a charitable arm focused on finding cost-effective ways to improve healthcare in underserved parts of the world using emerging technology. The Foundation trains local care teams in Tanzania and Kenya to use mobile diagnostic equipment for vision testing, providing custom prescription glasses to children and adults in these communities.
• SKYGENerosityminorOthersSKYGENerosity is SKYGEN's charitable giving program that enables employees and clients to collaborate to improve dental and vision health across communities through volunteering and donations.
• NADP (National Association of Dental Plans)coreOthersSKYGEN has been an active member of NADP for 20 years with representatives on nearly all NADP workgroups and commissions (Communications, EDI, Education, Government Funded Programs, Government Relations, Membership, Operations). This deep institutional engagement shapes industry standards and drives NADP's advocacy, research, and education mission.
• MSDA (Medicaid|Medicare|CHIP Services Dental Association)coreOthersSKYGEN's Chief Innovation & Growth Officer John Schaak serves on the MSDA Board of Directors. SKYGEN is recognized as a leader in dental benefits administration for Medicare and Medicaid programs and actively participates in MSDA's annual symposium and working groups.
• NAVCP (National Association of Vision Care Plans)minorOthersSKYGEN's Chief Client Success Officer Jeff Spahr and former executive Lisa Sweeney serve on the NAVCP Board of Directors. SKYGEN participates in NAVCP events and working groups to advance vision care benefits administration.

Scale indicators7 records

Recent moves6 records

Expansion highlights6 records

Broad incumbents

• Change Healthcare (Optum): Change Healthcare, now part of Optum, is a major healthcare technology provider with claims processing, payment integrity, and analytics capabilities. Its broad healthcare IT footprint overlaps with SKYGEN's claims automation and analytics offerings for payers.
• Elevance Health (Anthem): Elevance Health operates Blue Cross Blue Shield plans and offers dental and vision specialty benefits across commercial and government segments. Its size and integration across multiple benefit lines make it both a customer and a long-term competitive threat to SKYGEN's specialty benefits positioning.
• Humana: Humana is a major Medicare Advantage-focused insurer that has been expanding its dental and vision benefits offerings to compete for senior members. It competes with SKYGEN in Medicare Advantage dental and vision administration and D-SNP specialty benefits.
• UnitedHealthcare (Optum): UnitedHealth/Optum is the largest U.S. health insurer and operates a vertically integrated benefits administration technology stack including dental and vision. It represents both a potential customer (for white-label services) and competitor as it expands its specialty benefits platform capabilities.
• Delta Dental Plans Association: Delta Dental is the largest dental benefits carrier in the U.S., operating through 39 independent member companies. It competes with SKYGEN by offering both in-house administration and technology, serving commercial, government, and individual dental benefits markets.
• Guardian Life Insurance: Guardian Life offers dental, vision, and other specialty benefits to employers through its Group Benefits division. It competes with SKYGEN in the employer-sponsored dental and vision market, both as a carrier and increasingly through technology-enabled administration.

Direct peers

• Avesis: Avesis is a vision and dental benefits administrator providing managed care services to health plans, employers, and government programs. It is one of the closest direct competitors to SKYGEN's vision benefits automation business, serving similar commercial and government payer segments.
• DentaQuest: DentaQuest is a leading dental benefits administrator and one of the largest Medicaid dental managed care organizations in the U.S. It directly competes with SKYGEN in dental benefits administration, government program administration (Medicaid/CHIP), and TPA services for both commercial and government payers.

Emerging players

• Zelis: Zelis is a healthcare technology company providing payments optimization, claims integrity, and network management solutions. Its overlap with SKYGEN's EBM analytics, fraud/waste/abuse detection, and provider network management offerings makes it an adjacent competitor in payer-facing analytics.
• HealthEdge: HealthEdge provides a next-generation, SaaS-based core administrative processing platform (HealthRules Payor) for health plans. While primarily focused on medical claims, its modern cloud architecture and payer focus overlap with SKYGEN's enterprise SaaS approach and customer base.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/SKYGENUSA
• YouTubeyoutube.com/channel/UCh2jMEvFpPZMpNWtkWEojwg
• Facebookfacebook.com/SKYGENUSA
• LinkedInlinkedin.com/company/skygen-usa?trk=top_nav_home

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles14 records

Subsidiaries2 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Skygen USA