Member Advocate

At Crumdale our mission is to bring innovative, independent and transparent health, wellness and cost containment solutions directly to employers and through brokers in our exclusive partner network. Crumdale’s proprietary access and process puts the right vendors in place, holds vendors accountable, lowers costs and produces better outcomes.

We bring together innovative, independent and transparent health and wellness solutions for employer groups at lower costs while creating better outcomes for employees and their families. We leverage our extensive industry experience and relationships to partner with cutting edge innovators and thought leaders. We set ourselves apart through our commitment to the latest technology and techniques to deliver health, wellness and cost containment nationally. We provide employer groups and our broker network the ability to hold providers accountable, remove conflicts of interest and deliver superior solutions in a transparent way.

Member Advocate

The Member Advocate is charged with providing direct support to our group members to help them navigate their benefits and the healthcare system.    This position works with other Crumdale Partners’ business partners (Finance/Sales/Transformation Rx/Executive teams) as well as outside partners as necessary and reports directly to the Director of Member Advocacy.

Responsibilities and Principal Duties:

• Assist Crumdale members with accessing and navigating medical and RX benefits delivered through Crumdale
• Utilize technology to intake, classify, delegate, monitor and resolve member level issues for our Franklin Health plan customers.
• When appropriate, assist members with clinical care solutions that increase quality and drive down costs.
• Work with external parties to secure access to their systems to provide our member advocates with the tools they need to resolve member issues completely in an accurate manner.
• Coordinate internal and external parties to promote case management of members enrolled in our health plans.
• Utilize external parties to improve care navigation of our health plan members.
• Be familiar with and follow agency E&O procedures and guidelines.
• Any other projects or duties assigned by Executive management.

• Bachelor’s degree preferred.
• Fluent in Spanish at level to be able to explain complicated health insurance concepts to Spanish speaking members
• Experience in a similar role at a comparable level in employee benefits not required, but a plus.
• High level of knowledge about the benefits we service including self-funded health plans, stop loss and PBMs.
• Some technical knowledge in all components of contracts, plan design, claim processes, and vendor capabilities.
• Proficiency in Microsoft Office applications required, experience with Zendesk a plus.
• Excellent interpersonal, verbal/written communication in English and Spanish, and presentation skills required.
• A passion for learning and an intense curiosity
• Logical approach to problem solving.
• Self-directed with positive drive and approach, including the ability to work both independently and collaboratively in both a virtual and in-person working environment.
• Must be detail-oriented, have highly developed organizational skills including the ability to prioritize, handle multiple projects simultaneously, and manage strict deadline and turnaround time requirements.
• Ability to establish credibility at all levels of the organization and with clients through confident communications and actions based on integrity.

At Crumdale, we strive to provide a comprehensive and supportive benefits package to ensure the well-being of our employees. Our benefits include:

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

Please note: Crumdale Specialty is not engaging with external recruitment agencies; please refrain from contacting us regarding this position.