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Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.Job Posting TitleSr. Research Specialist - Bilingual (English-Spanish)Job DescriptionThe Senior Research Specialist is responsible for researching and resolving member complaints, determining resolution, and providing written communication to members and clients within established turnaround times. We are seeking bilingual (English-Spanish) candidates proficient in reading, speaking and writing.Responsibilities
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
Utilize Prime’s internal systems to 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
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
Take member service and assist line calls as needed
Other duties as assigned
Minimum Qualifications
High School Diploma from an accredited school or equivalent GED
3 years of experience in Customer Service, Medicaid/Medicare benefit plans, or Grievances or Appeals
1 year of escalation resolution experience
Must be eligible to work in the United States without 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
Strong interpersonal communication skills, including conflict resolution and listening skills
Ability to work under strict timelines with while managing priorities simultaneously
Ability to maximize interdepartmental and client resources
Ability to exceed established Key Performance Indicators (KPIs)
Preferred Qualifications
Bilingual in English-Spanish
Associate’s or Bachelor’s degree in business, healthcare or related area of study, or equivalent combination of education and/or related work experience
Experience drafting professional correspondence
Certified Pharmacy Technician (CPhT) with pharmacy benefit management experience
Experience using internal systems
Healthcare experience, preferred pharmacy benefit management (PBM) and/or Government Programs (Medicare/Medicaid) experience
Minimum Physical Job Requirements
Constantly required to sit, use hands to handle or feel, talk and hear
Frequently required to reach with hands and arms
Occasionally required to stand, walk and stoop, kneel, and crouch
Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
Reporting Structure
Reports to a Manager or Supervisor in the Clinical Review Operations or Member Services department
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage qualified minority, female, veteran, disabled, and other diverse candidates to apply and be considered for open positions. Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage qualified minority, female, veteran, disabled, and other diverse candidates to apply and be considered for open positions. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.
