Research Specialist Lead - Remote
Prime Therapeutics · Remote · remote · Posted 36d ago
Undisclosed4–9 yrsfulltimeSourced from
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About this role
Job Summary
Responsibilities
Minimum Qualifications
Additional Qualifications
Preferred Qualifications
Security & Compliance
Disclaimer: This job posting and Location has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.
The Lead Research Specialist position (Remote) is responsible for researching and resolving complex and escalated member issues while ensuring accurate, timely, and compliant outcomes. This position serves as a subject matter expert by providing guidance on research decisions, documentation, and written communications, and by supporting quality and consistency in case handling. This role also contributes to reporting, process improvements, and operational support to help meet service levels and performance expectations.
Responsibilities
- Apply advanced knowledge of policies, procedures, and benefit design to evaluate and resolve complex or sensitive cases, ensuring sound and compliant decision-making
- Serve as a subject matter expert by guiding research strategies, documentation standards, and the development of clear, accurate written responses
- Review and validate case documentation and correspondence for accuracy, clarity, consistency, and regulatory or policy compliance
- Assess cases to determine the need for escalation, reclassification, or additional review, and initiate appropriate actions to ensure timely resolution
- Contribute to reporting, tracking, and documentation activities that support service-level adherence, and performance monitoring
- Identify opportunities for process, workflow, or quality improvements and support initiatives that enhance consistency, efficiency, and overall case handling effectiveness
- 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
- 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
- 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 Qualifications
- 2 years of escalation resolution experience
- Experience drafting professional correspondence
- Prior healthcare and/or Government Programs (Medicare/Medicaid) experience
Security & Compliance
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.
Disclaimer: This job posting and Location has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.
Sourced from naukri
Skills
Customer Servicesubject matter expertcase documentationPerformance monitoringoperational supportPolicy ComplianceMedicaidmedicaresecurity controlsPharmacyHealthcareResearchCommunication SkillsLegalcompliance
About Prime Therapeutics
Prime Therapeutics
Eagan
US
About
Prime Therapeutics is a pharmacy benefit management company that partners with health plans, employers, and government programs to provide cost-effective prescription drug services. It focuses on improving patient outcomes by managing medication access, affordability, and adherence. Through integrated solutions and collaborative care, Prime Therapeutics helps millions of members optimize their pharmacy benefits while reducing overall healthcare costs.
Industries
Health CarePharmaceutical
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