Role Description 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 - 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. Qualifications - 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 Description 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.

• Support daily pharmacy operational workflows and administrative tasks to ensure timely and accurate prescription processing • Assist with prescription drafting preparation and documentation workflows for clinician review and signature • Monitor operational queues and escalate delays, missing information, or workflow concerns appropriately • Maintain accurate documentation within prescribing platforms, EHRs, pharmacy systems, and internal operational tools • Ensure assigned tasks are completed efficiently, accurately, and in accordance with SOPs and compliance requirements • Provide frontline operational support to clinicians and internal teams for routine pharmacy workflow questions and requests • Assist with resolving straightforward operational issues using established workflows and guidance from senior team members • Escalate complex, clinical, or technical issues appropriately and with clear documentation • Support member-facing pharmacy workflows, including prescription status updates and coordination tasks • Collaborate with the CX team to assist with basic prescription-related member issues and inquiries • Help ensure members receive timely communication and operational support related to pharmacy workflows • Develop foundational knowledge of prescription lifecycles, pharmacy fulfillment processes, and operational workflows • Identify workflow inefficiencies or recurring issues and communicate observations to senior team members • Support process improvement initiatives, audits, reporting tasks, and operational cleanup efforts as assigned • Demonstrate curiosity, initiative, and willingness to learn new systems and workflows • Follow established SOPs, regulatory requirements, privacy standards, and quality expectations consistently • Support documentation, audit preparation, and quality assurance activities as needed • Maintain a high level of accuracy and attention to detail across all assigned work • Perform other duties as assigned to support evolving clinical, operational, and business needs

• System Monitoring and Alerting: Develop and implement robust monitoring systems to identify potential failures, especially post-deployment, ensuring high system reliability and performance. • Deployment Standards: Define and maintain standards for all deployments. Ensure that each new solution or change includes comprehensive runbooks, alerts, and metrics. • Incident Management: Manage and coordinate responses to incidents with urgency and efficiency. Lead the creation of thorough post-mortem analyses to prevent future occurrences. • Documentation and Testing: Consolidate and maintain up-to-date documentation on client configurations. Ensure all configurations are thoroughly tested and functioning optimally. • Problem-Solving Support: Provide expert context and assistance in resolving issues during production incidents. • Team Coordination: Oversee and coordinate the work of technical customer support agents, ensuring effective and client-focused support. • Roadmap planning: Present regular summary reports of the overall operational health of the organization and opportunities for improvement. Manage and drive the roadmap for operational improvements.

• Lead, mentor, and develop a team of Program Managers, fostering a culture of accountability, continuous improvement, and high performance. • Set clear performance expectations, provide ongoing coaching and feedback, and conduct regular career development conversations to grow and retain top talent. • Serve as a strategic thought partner to S&O and functional leadership, translating business priorities into structured, measurable programs with clear owners and milestones. • Oversee program management for Trust & Safety initiatives, including the design, launch, and iteration of policies and enforcement workflows that protect users and maintain platform integrity. • Lead programs supporting the company's risk management and regulatory compliance obligations, ensuring work is executed on time and meets internal and external standards. • Drive cross-functional collaboration with Legal, Policy, Engineering, Product, and Finance to translate Trust & Safety and compliance priorities into operational programs. • Manage programs that bridge Product and Trust & Safety teams, ensuring seamless go-to-market readiness, feature launches, and operational handoffs. • Establish and maintain operational playbooks, escalation frameworks, and KPIs to measure the effectiveness of programs across all three pillars. • Identify structural inefficiencies, emerging risks, and gaps in existing operations; develop and implement scalable solutions with measurable impact. • Lead quarterly and annual planning cycles for the team, including OKR setting, resource allocation, and roadmap development. • Build executive-ready reporting, performance narratives, and strategic recommendations that drive clarity and alignment at the senior leadership level. • Drive change management efforts associated with new programs, policies, tooling launches, or organizational models.