Research Specialist Lead

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $21 - $31 / hour

⏰ Full Time

🟠 Senior

🔬 Research Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Prime Therapeutics

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1998

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Prime Therapeutics is a trusted pharmacy solutions provider dedicated to transforming health care through innovation and transparency. The company offers a wide range of services including clinical solutions for improved member outcomes, drug access and affordability, specialty drug management, and condition management for chronic health issues. With over 7,000 employees, Prime Therapeutics aims to challenge norms in the pharmacy industry, providing exceptional experiences and simplifying the complex for millions across the nation. Their mission goes beyond profit, focusing on creating transformative impacts with long-term solutions, utilizing modern technology and holistic approaches in specialty pharmacy management. Owned by mission-driven partners, Prime Therapeutics emphasizes true transparency and conflict-free service, fostering a culture of care and shared purpose in health care.

📋 Description

• Research and resolve complex and escalated member issues • Ensure accurate, timely, and compliant outcomes • Provide subject matter expertise on research decisions, documentation, and written communications • Support quality and consistency in case handling • Review and validate case documentation and correspondence • Assess cases for escalation, reclassification, or additional review • Initiate appropriate actions to ensure timely resolution • Contribute to reporting, tracking, and documentation supporting service-level adherence and performance monitoring • Identify and support process, workflow, and quality improvements • Perform other duties as assigned

🎯 Requirements

• High School diploma from an accredited school or equivalent GED • 4 years of work experience in customer service, benefit plans, grievances or appeals • Must be eligible to work in the United States without the need for work visa or residency sponsorship • Ability to be self-motivated and work with minimal supervision • Strong organizational, analytical, interpretive, problem solving and time management skills • Strong interpersonal communication skills, including conflict resolution and listening skills • Ability to work under strict timelines while managing priorities simultaneously • Ability to maximize interdepartmental and client resources • Preferred: 2 years of escalation resolution experience • Preferred: Experience drafting professional correspondence • Preferred: Prior healthcare and/or Government Programs (Medicare/Medicaid) experience • Must understand, comply with, and attest to job-specific security responsibilities and controls • Must comply with applicable legal, regulatory, contractual, and internal policy requirements • Must be able to perform the essential functions of the job

🏖️ Benefits

• Benefits, incentives, and additional compensation are available; see the Benefits at a glance page • Reasonable accommodations for employees with disabilities • Equal opportunity and affirmative action employment • Tobacco-Free Workplace