Crumdale Specialty

Eligibility & Configuration Analyst

Crumdale Specialty

full-time

Posted on:

Location Type: Remote

Location: Pennsylvania • United States

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Tech Stack

VBA

About the role

  • **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

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
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
eligibility operationsEDI processingclaims system configurationdata reconciliationexception managementfile formatsCSVJSONflat filesVBA
Soft Skills
analytical skillscommunication skillsvendor management skillsability to balance competing prioritiesmeet SLAsdrive operational accuracycollaborationoperational excellence