Account Operations Services Manager

About Crumdale Specialty:

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. We optimize the fragmented health benefits supply chain to reduce health benefit costs and create better outcomes for employers and employees.

At Crumdale, people come first. We strive to make a positive impact on the people we serve. We believe this starts with the passion and purpose of our team. Our company culture is rooted in alignment, innovation, and integrity.

About the Job:

The Account Operations Services Manager will provide hands-on team and client support including, but not limited to, external reinsurance reimbursement management, internal company operations related to TPA, PBM invoices and accounts receivable, and stop loss audit filing research and presentation. In addition, this role is critical in developing and leading process documentation in support of improving the company’s ecosystem relationships and delivery with stoploss carriers, MGU’s, TPAs, Pharmacy Benefit Managers (PBMs), Broker Partners, and Clients. It is crucial to ensure internal and external processes are well documented, evaluated, and in a cycle of continuous improvement. The goal is to ensure the company’s program is driving measurable, innovative, and sustainable improvement for all stakeholders.

The company is using cutting edge technology and techniques to disrupt the insurance marketplace. Their dynamic, entrepreneurial environment will expose you to many different facets of the business. This is an exciting position where no two days are the same.

Requirements

Key Responsibilities:

• Evaluate existing process, document gaps, collaborate with the appropriate teams, and implement solutions supporting channel partners and internal stakeholders
• Participate in process reviews to identify bottlenecks and understand the business environment to recognize the “why”; build scalable solutions that contribute to solve problems that will help grow our business
• Utilize expertise to assist and resolve escalations that require attention outside of Account Management or stoploss operations teams
• Support the Account Management and Implementation teams to ensure a smooth landing for new and renewing brokers, customers and members
• Help grow and develop technology solutions in support of a sustainable, systematic approach to tracking all activity impacting customers, brokers and members
• Develop a deep understanding of the company, and the companies they represent, including products and services
• Track TPA & PBM invoices and follow up on significant outstanding AR
• Track vendor per claim fees and address any discrepancies with our accounting team and the TPA.
• Track duplicate claims found during stop loss audits and help ensure corrections are made with the TPA.
• Monitor claims with specific thresholds and escalate them for review when needed.
• Support Account Managers with stop loss denials (for any reason) by reviewing denied claims and helping communicate next steps to clients and brokers
• Engage with SL carriers, internal and external for non-implementation work
• Assist in training new employees and orient them to process and documentation
• Any other projects and needs that arise requested by the leadership team

Specialized Skills & Experience:

• 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
• The ability to work equally well autonomously and as part of cross-functional teams
• Excellent written and oral communication
• Strong analytical skills and the ability to pay attention to details
• Proficient in Microsoft Office Suite (Outlook, PowerPoint, Word, Excel)

Benefits

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