Job Description

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. At Crumdale, people come first. Our culture is rooted in alignment, innovation, accountability, and integrity.

About the Role

We are hiring a Technical Operations Analyst to own inbound and outbound file operations, vendor data integrations, and reporting across our growing TPA environment. This role will serve as the central hub for file management, data movement, and operational reporting; ensuring accurate, timely, and scalable data exchange across all partners including networks, PBMs, and other vendors.

This position is highly technical and data-focused, requiring strong SQL skills, deep understanding of TPA workflows, and the ability to translate business needs into reliable reporting and file solutions.

Key Responsibilities

1. File Operations & Data Exchange Management

• Own all inbound and outbound file processes across vendors (PBM, networks, medical management, etc.).
• Monitor, validate, and reconcile daily file activity (eligibility, claims, accumulators, EOBs, etc.).
• Ensure proper file formatting, delivery, acknowledgments, and error resolution.
• Troubleshoot and resolve file failures across SFTP connections, vendors, and internal systems.
• Maintain and optimize file workflows to support scalability and automation.

2. Vendor Integration Oversight

• Serve as the primary technical contact for vendor file integrations.
• Manage connectivity across SFTP platforms, APIs (where applicable), and vendor data exchanges.
• Coordinate with vendors and claims system to resolve discrepancies, mapping issues, and data inconsistencies.
• Ensure alignment between vendor requirements and internal system capabilities.

3. Reporting & Data Analytics

• Build, maintain, and enhance operational and client-facing reports using SQL.
• Translate business and client reporting needs into scalable data solutions.
• Support reporting across eligibility, claims, accumulators, and vendor data.
• Partner with internal teams (Account Management, Claims, Finance) to deliver accurate reporting insights.

4. Data Quality & Reconciliation

• Perform cross-system data audits between claims system, vendor outputs, and internal reporting.
• Identify and resolve root causes of data discrepancies (eligibility, claims, accumulators).
• Ensure consistency of data across all downstream systems and vendor partners.
• Develop processes to proactively monitor and improve data quality.

5. Implementation & Go-Live Support

• Support new client implementations from a file and reporting readiness perspective.
• Ensure all vendor file connections are tested, validated, and operational prior to go-live.
• Partner with implementation and TechOps leadership to meet critical deadlines and dependencies.
• Assist in defining file requirements, layouts, and reporting needs for new clients.

6. Operational Process Improvement

• Develop and maintain SOPs for file management, error handling, and reporting processes.
• Identify opportunities for automation, efficiency improvements, and standardization.
• Support the evolution of a scalable TPA operating model as client and vendor volume grows.

Requirements

• 5+ years of experience in TPA operations, healthcare data operations, EDI, or technical operations.
• Strong experience managing inbound/outbound file processing across multiple vendors.
• Advanced SQL skills required (data extraction, transformation, reconciliation, reporting).
• Experience with file formats such as 834, 835, 837, CSV, flat files, JSON.
• Hands-on experience with SFTP platforms and file automation workflows.
• Strong understanding of TPA ecosystem (eligibility, claims, accumulators, PBM, network integrations).
• Proven ability to troubleshoot complex data and file issues across systems and partners.
• Strong analytical mindset with attention to detail and data accuracy.
• Excellent communication skills with both technical and non-technical stakeholders.

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.