Research Specialist Lead

Prime Therapeutics

. Research and resolve complex and escalated member issues .

Posted 9/15/2026full-timeRemote • United StatesSenior💰 $21 - $32 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in resolving complex member issues while ensuring compliance and quality in case handling. Proficient in documentation, communication, and process improvement within customer service and healthcare environments.

Highest-signal resume keywords

Customer Service ExperienceEscalation ResolutionHealthcare KnowledgeAnalytical SkillsInterpersonal Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case DocumentationProblem SolvingTime ManagementQuality ImprovementWorkflow Optimization

Soft Skills

Organizational SkillsConflict ResolutionListening SkillsSelf-Motivation

Industry Keywords

Benefit PlansGrievancesAppealsMedicareMedicaid

About the role

Key responsibilities & impact

Research and resolve complex and escalated member issues
Ensure accurate, timely, and compliant outcomes
Provide subject matter expertise on research decisions, documentation, and written communications
Support quality and consistency in case handling
Review and validate case documentation and correspondence
Assess cases for escalation, reclassification, or additional review
Initiate appropriate actions to ensure timely resolution
Contribute to reporting, tracking, and documentation supporting service-level adherence and performance monitoring
Identify and support process, workflow, and quality improvements
Perform other duties as assigned

Requirements

What you’ll need

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
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: 2 years of escalation resolution experience
Preferred: Experience drafting professional correspondence
Preferred: Prior healthcare and/or Government Programs (Medicare/Medicaid) experience
Must understand, comply with, and attest to job-specific security responsibilities and controls
Must comply with applicable legal, regulatory, contractual, and internal policy requirements
Must be able to perform the essential functions of the job

Benefits

Comp & perks

Benefits, incentives, and additional compensation are available; see the Benefits at a glance page
Reasonable accommodations for employees with disabilities
Equal opportunity and affirmative action employment
Tobacco-Free Workplace