GPRTResearchSpecialistLead

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_** GPRT Research Specialist Lead ## _**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 Uni