Eligibility & Configuration Analyst

🕒 March 17

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $75k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 45%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• 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 with the claims system team, external vendors, and internal stakeholders • Manage file connections across BenAdmin platforms, PBM, networks, CMS, and other partners • 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 • Ensure timely and accurate eligibility for ID card production, claims adjudication, billing, and reporting • Build and configure new employer groups within the VBA claims system • Configure benefits, billing rules, workflows, and plan structures • Maintain configuration integrity for claims, billing, reporting, and member support • Configure ID card rules and maintain digital ID card templates and PDFs • Execute quick-turn ID card updates driven by eligibility or plan changes • Support new client implementations through 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 smooth and timely go-live • Maintain SOPs for eligibility workflows, reconciliations, and file exception handling • 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

• Medical • Telemedicine • Dental • Vision • Life, AD&D, Disability • 401(k) • Flexible Time-off