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

Job 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.

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).

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.