Note: The job is a remote job and is open to candidates in USA. Crumdale Specialty is a diversified insurance firm providing custom, self-funded healthcare solutions. The Technical Operations Analyst will manage file operations, vendor data integrations, and reporting, ensuring accurate data exchange across partners in a growing TPA environment.
Responsibilities
- 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
- 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
- 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
- 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
- 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
- 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
Skills
- 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
- Medical
- Telemedicine
- Dental
- Vision
- Life, AD&D, Disability
- 401(k)
- Flexible Time-off
Company Overview
Crumdale Specialty is an insurance firm providing custom and self-funded healthcare solutions. It was founded in 2014, and is headquartered in Paoli, Pennsylvania, USA, with a workforce of 51-200 employees. Its website is https://crumdalespecialty.com.