Crumdale Specialty

Crumdale Specialty is dedicated to revolutionizing the insurance industry through innovative products and cost-saving solutions, aiming to deliver customers bet

Eligibility & Configuration Analyst

AnalystAnalystFull TimeRemoteSeniorCompany Site

Location

Pennsylvania

Posted

2 days ago

Salary

Not specified

Seniority

Senior

Professional Certificate5 yrs expEnglishVBA

Job Description

**Key Responsibilities** **1. 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 **2. 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 **3. 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 **4. 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 **5. 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 **6. 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

Job 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

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