[Remote] Technical Operations Analyst

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