GPRT Research Specialist Lead

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
• Absess 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

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

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
• Maximize interdepartmental and client resources

Additional Qualifications

• 2 years of escalation resolution experience
• Experience drafting professional correspondence
• Prior healthcare and/or Government Programs (Medicare/Medicaid) experience

Pay

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.

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)