Research Specialist Lead - Govt Programs - Remote

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Job Description

The Senior Research Specialist is responsible for researching and resolving member concerns, determining resolution, and providing written communication to members and clients within established turnaround times.

Responsibilities

• Utilize Prime's internal systems to conduct thorough research and reply to questions and escalated issues from Prime's internal and external partners in a timely manner and escalate or re-classify issues as appropriate
• Provide clients, members and pharmacies (Pharmacy Benefit Manager (PBM) Support Teams) with information regarding benefit plans to assure accurate claims processing and client/member satisfaction research
• Communicate issue resolution results per standard operating procedures in a timely manner
• Serve as a subject matter expert (SME), assisting with technical questions, workflow or process direction and coordinate peer letter review process
• Collaborate with the supervisor to identify process and/or quality improvement opportunities and assist in the implementation of solutions and assist leadership with various projects as needed
• Complete accurate reporting as needed/requested
• Other duties as assigned

Minimum Qualifications

• High School diploma from an accredited school or equivalent GED
• 4 years of work experience in customer service, benefit plans, grievances or appeals in the Medicare space, preferably in PBM Medicare space

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Ability to be self-motivated and work with minimal supervision
• Strong organizational, analytical, interpretive, problem solving and time management skills
• Ability to make consistent and unbiased decisions
• Strong verbal and written communication skills including formal business letter writing
• 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
• Ability to exceed established Key Performance Indicators (KPIs)

Preferred Qualifications

• Higher education degree
• Experience drafting professional correspondence
• 1 year of escalation resolution experience
• Certified Pharmacy Technician (CPhT)
• Pharmacy benefit management experience
• Prior Healthcare and/or Government Programs (Medicare/Medicaid) experience
• Experience using internal systems (e.g. RxClaims, Salesforce, Confluence)
• Call Center experience

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.  

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.