Account Operations Services Manager

🔥 4 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 12%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

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• No salary listed.

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Crumdale Specialty

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2014

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

Crumdale Specialty is a diversified insurance firm providing custom, self-funded healthcare solutions to a bespoke set 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, offering integrated health plans, stop loss group captives, and pharmaceutical benefit solutions.

📋 Description

• Evaluate existing processes, document gaps, collaborate with appropriate teams, and implement solutions supporting channel partners and internal stakeholders • Participate in process reviews to identify bottlenecks, understand the business environment, and build scalable solutions • Resolve escalations requiring attention outside Account Management or stop-loss operations teams • Support Account Management and Implementation teams for new and renewing brokers, customers, and members • Develop technology solutions for systematically tracking activity impacting customers, brokers, and members • Develop deep understanding of the company, represented companies, products, and services • Track TPA and PBM invoices and follow up on significant outstanding accounts receivable • Track vendor per-claim fees and address discrepancies with accounting and the TPA • Track duplicate claims found during stop-loss audits and help ensure corrections with the TPA • Monitor claims with specific thresholds and escalate for review when needed • Support Account Managers with stop-loss denials by reviewing denied claims and communicating next steps to clients and brokers • Engage with stop-loss carriers for non-implementation work • Assist in training and orienting new employees on processes and documentation • Complete other projects and needs requested by leadership

🎯 Requirements

• Excellent customer service skills with a high level of customer focus, motivation and follow through, and confidence to engage with brokers and clients • Ability to work in a fast-paced environment with excellent prioritization, project management, problem solving and time management skills • Ability to work equally well autonomously and as part of cross-functional teams • Excellent written and oral communication • Strong analytical skills and attention to detail • Proficient in Microsoft Office Suite (Outlook, PowerPoint, Word, Excel)

🏖️ Benefits

• Medical insurance • Vision insurance • Dental insurance • 401(k) • Disability insurance • Flexible PTO

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