研究专员负责人 - 远程
Research Specialist Lead - Remote
在Prime Therapeutics（Prime），我们是一家与众不同的药房福利管理公司，我们的目标超越利润，拥有独特的连接关怀的能力，为所服务的人提供支持。寻找一个有使命感的职业？与我们一同打造药品行业的未来。
职位发布标题
研究专家主管 - 远程职位 描述
主管研究专家职位负责研究和解决复杂的成员问题，并确保结果准确、及时且符合规定。该职位通过提供研究决策、文档和书面沟通方面的指导，成为专业领域专家，并支持案例处理的质量和一致性。该职位还参与报告、流程改进和运营支持，以帮助满足服务水平和绩效期望。
职责
- 运用对政策、程序和福利设计的高级知识，评估并解决复杂或敏感的案例，确保决策合理且合规
- 作为专业领域专家，指导研究策略、文档标准以及清晰、准确的书面回复的开发
- 审核并验证案例文档和通信内容的准确性、清晰度、一致性和法规或政策合规性
- 评估案例以确定是否需要升级、重新分类或进一步审查，并启动适当的措施以确保及时解决
- 参与报告、跟踪和文档活动，以支持服务级别遵守情况，并进行绩效监控
- 识别流程、工作流或质量改进的机会，并支持提升一致性、效率和整体案例处理效果的举措
- 其他指派的职责
最低资格要求
· 从认证学校获得高中文凭或同等学历的GED
· 在客户服务、福利计划、投诉或申诉领域有4年工作经验
必须具备在美国工作的资格，无需工作签证或移民担保
其他资格
- 具备自我驱动力，能够在较少监督的情况下工作
- 强大的组织、分析、解读、解决问题和时间管理能力
- 强大的人际沟通能力，包括冲突解决和倾听技能
- 能够在严格的时间限制下同时管理优先事项
- 能够最大化利用跨部门和客户资源
- 首选资格
查看英文原文
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 - RemoteJob Description
The Lead Research Specialist position 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
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 (
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.
Originally posted on Himalayas