Research Specialist Lead - Govt Programs - Remote

Prime Therapeutics•Home, WV

10d•$21 - $32•Remote

About The Position

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 Research Specialist Lead - Govt Programs - Remote 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.

Requirements

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
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)
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.

Nice To Haves

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

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

Benefits

Potential pay for this position ranges from $21.15 - $31.73 based on experience and skills.
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).

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