Eligibility & Configuration Analyst

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.