Crumdale Specialty

Operations

• - Oversee end-to-end Specific, Aggregate, and Level-Funded stop loss claims processing, ensuring compliance with policy provisions, regulatory standards, and Crumdale’s internal protocols
• - Schedule, track, and review complex aggregate and level-funded claims and financial reconciliations for accuracy, eligibility, and reimbursement integrity
• - Ensure timely adjudication and resolution of claims, including coordination with internal departments as well as TPAs, PBMs, audit vendors, carriers, and external MGU partners
• - Lead, mentor, and develop a team of Stop Loss Claims Analysts
• - Establish performance metrics and ensure continuous improvement in claims operations
• - Foster a collaborative and accountable team culture
• - Serve as a liaison with stop loss carriers for complex claims and policy administration-related matters
• - Serve as the primary liaison with external MGU partners to ensure seamless stop loss claims operations
• - Negotiate and resolve claims disputes with providers and carriers
• - Ensure seamless integration of claims data via APIs and file feeds
• - Ensure adherence to federal and state regulations, including ERISA and HIPAA
• - Maintain accurate records and generate monthly and quarterly claims performance reports
• - Support internal audits and regulatory reviews

Director – Stop Loss Operations

Procurement

• Act as Crumdale’s external stop loss subject matter expert responsible for developing relationships with stop loss carrier partners
• Assist in driving sales and renewals through negotiation with those carriers
• Work closely with the Regional Sales Directors to identify opportunities to drive sales
• Increase the number of competitive stop loss quotes produced by Crumdale
• Direct and coordinate all components for the development of new and renewal business
• Drive forward the orchestration and execution of stop loss related sales initiatives as directed by leadership
• Develop strong stop loss carrier partnerships
• Mastery of Crumdale’s cost containment programs
• Work closely with the Pricing team to develop proper quote requests
• Negotiate proposals to secure the best possible quotes
• Communicate consistently across the Pricing and Sales teams
• Build trust and alignment across the organization

Strategic Stop Loss Sourcing Manager

Attorney

• Draft, review, and negotiate contracts including confidentiality agreements, vendor agreements, employment agreements, and service-level agreements
• Ensure contracts align with Crumdale Specialty’s strategic goals and regulatory obligations
• Collaborate with business units, including Captive Sales, Underwriting, and Operations, to support deal structuring and implementation
• Support dispute resolution and contract enforcement as needed
• Maintain organized contract records and contribute to process improvements in contract management

In-House Attorney

Account Executive

• Designated lead point of contact for assigned clients and own overall and day-to-day client service delivery; Responsible for the overall establishment and maintenance of a successful and lasting client relationship while supporting all aspects of each client’s account; Create unique consultative partnerships with each client group to achieve their designated outcomes or goals; Build relationships with brokers, consultants, TPA and employers; Managed and support the successful implementation of client prescription benefit plan and ongoing communication for our partnerships; Accountable for client satisfaction and retention; Participates in client meetings and finalist presentations; Present and support client presentations with a focus on trends identified from client’s data; Support key client groups on areas including contract renewal, pricing, benefit or clinical program changes; Ensure a successful new client implementation and smooth transition of client from other organizations; Ensure delivery and accuracy of client’s pharmacy deliverables (e.g. invoices, rebates, true-ups, reports, performance reviews); Manage ongoing contract relationships and service delivery to clients with a focus on the pharmacy benefit; Monitor progress to deadlines; Ensure appropriate and effective communication among team members, the client, their advisors, and the PBM; Communicate issues internally and provide support to resolve benefit escalated questions and service issues; Assist with the preparation and presentation of deliverables and outcomes; Support the pharmacy practice on internal marketing or intellectual capital initiatives; Partners with internal Account Managers to address client needs and proactively management the pharmacy benefit program; Represent client internally and coordinates with other functions to implement client systems, complete projects, and address ongoing service needs; Own new client relationship from implementation through renewals; Own client’s performance review process; Product consultation and upsell; Contract negotiations; Pharmacy trend management and cost containment

Strategic Account Executive, PBM/Pharmacy

Accountant

• About Crumdale Specialty: Crumdale Specialty is a diversified insurance firm providing custom, self-funded healthcare solutions to a limited distribution network of brokers, consultants, and agents nationwide. Ranked on the Inc. 5000 Fastest Growing Companies and Best Workplaces, we leverage industry expertise, superior talent, data analytics, and a disruptive mindset to manufacture, underwrite, and administer agile, transparent, and cost-saving solutions. We optimize the fragmented health benefits supply chain to reduce health benefit costs and create better outcomes for employers and employees.
• At Crumdale, people come first. We strive to make a positive impact on the people we serve. We believe this starts with the passion and purpose of our team. Our company culture is rooted in alignment, innovation, and integrity.
• About the Job: The Staff Accountant will join the collegial and collaborative Crumdale Accounting/Finance team to support accounting, billing, and banking activities related to Crumdale’s self-insured healthcare product/program. This position will work closely with the team in executing the monthly program cycle including preparing and presenting invoices, related accounting entries, banking transactions (both collections and vendor payments), and reconciliations. This team member will also contribute to other aspects of the overall accounting function at Crumdale, including our pharmacy and medical stop loss solutions, among other areas.
• Our dynamic, entrepreneurial environment exposes all employees to many different facets of Crumdale’s proprietary business model and the health insurance industry in general. This is an exciting position where no two days are the same.

Staff Accountant

Marketing

• About Crumdale Specialty is a diversified insurance firm providing custom solutions to businesses nationwide. We leverage industry expertise, superior talent, and a disruptive mindset to provide agile, transparent, and cost-saving solutions to optimize self-funded health plans. Founded in 2014, we are the fastest-growing purveyor of integrated insurance solutions, with deep-rooted experience in program management, TPA administration, PBM consulting, stop-loss coverage, compliance, risk management, underwriting, and analytics.
• At Crumdale, people come first. Our clients, colleagues, trading partners, and communities are our strength. Our company culture is rooted in alignment, innovation, and integrity. We are proud to be named an Inc. Magazine Best Places to Work in multiple years.
• We are seeking a dynamic and resourceful Marketing Associate to join our fast-paced, high-growth marketing team. Reporting to the Vice President of Marketing, this role will support day-to-day marketing initiatives across the business, including project management, social media, events, and content coordination. The ideal candidate is organized, creative, digitally savvy, and eager to learn and grow within a collaborative and mission-driven environment.