Description About Crumdale Specialty: Crumdale Specialty is a diversified insurance firm providing custom, self-funded healthcare solutions. Our dedication to leveraging industry expertise, superior talent, data analytics, and a disruptive mindset enables us to manufacture, underwrite, and administer agile, transparent, and cost-saving solutions tailored for brokers, consultants, and agents nationwide.
We take pride in our culture of alignment, innovation, and integrity, and we’ve been recognized on the Inc. 5000 Fastest Growing Companies and Best Workplaces lists.
Position Overview
Crumdale Specialty is seeking an experienced
Eligibility & Configuration Analyst
to lead eligibility operations, vendor file exchanges, client configuration, and claims system setup for our rapidly growing TPA. This role serves as the operational hub for eligibility, EDI integrations, and claims system configuration—ensuring clean data, smooth workflows, and seamless experiences for clients, vendors, and internal teams.
Key Responsibilities
Systems & Vendor Integration
Act as the primary operational contact for eligibility and enrollment vendors
Monitor daily inbound/outbound eligibility files, validating formats, tracking, and acknowledgments
Troubleshoot file errors in partnership with the claims system team, external vendors, and internal stakeholders
Manage file connections across BenAdmin platforms, PBM, networks, CMS, and other partners
Eligibility Operations & Data Quality
Maintain, update, and audit eligibility data across systems (including VBA)
Perform discrepancy research and root‑cause analysis across PBM, network, and claims data feeds
Process manual enrollments, terminations, and demographic changes as needed
Ensure timely and accurate eligibility for ID card production, claims adjudication, billing, and reporting
Claims System Configuration
Build and configure new employer groups within the claims system (VBA)
Configure benefits, billing rules, workflows, and plan structures to support downstream teams
Maintain configuration integrity to ensure claims, billing, reporting, and member support function without system barriers
ID Card Configuration
Configure ID card rules within claims and vendor systems
Create and maintain digital ID card templates and PDFs
Execute quick‑turn card updates driven by eligibility or plan changes
Implementation Support
Support new client implementations by preparing EDI, configuration, connectivity, and operational readiness
Track milestones and dependencies across PBM, networks, vendors, ID cards, billing, and portals
Collaborate with internal teams and external partners to ensure a smooth and timely go‑live
Operational Excellence
Maintain SOPs for eligibility workflows, reconciliations, and file exception handling
Ensure data integrity and operational efficiency as membership and vendor volume scales
Partner cross‑functionally with Billing, Claims, Customer Care, Networks, and IT teams
Requirements
5+ years of experience in eligibility operations, EDI processing, or healthcare/TPA operations
Strong understanding of eligibility file formats (CSV, JSON, flat files; 834 experience a plus)
Claims system configuration experience strongly preferred (VBA or similar platform)
Excellent analytical skills, including comfort with data reconciliation and exception management
Strong communication and vendor‑management skills
Ability to balance competing priorities, meet SLAs, and drive operational accuracy in a fast‑paced environment
Benefits
At Crumdale, we strive to provide a comprehensive and supportive benefits package to ensure the well-being of our employees. Our benefits include:
Medical
Telemedicine
Dental
Vision
Life, AD&D, Disability
401(k)
Flexible Time-off
Please note:
Crumdale Specialty is not engaging with external recruitment agencies; please refrain from contacting us regarding this position.