Job Details

ID #2782366
Estado Nebraska
Ciudad Omaha / council bluffs
Full-time
Salario USD TBD TBD
Fuente Prime Therapeutics LLC
Showed 2019-10-17
Fecha 2019-10-17
Fecha tope 2019-12-15
Categoría Etcétera
Crear un currículum vítae

Sr. Research Specialist - Bilingual (English-Spanish)

Nebraska, Omaha / council bluffs 00000 Omaha / council bluffs USA

Vacancy caducado!

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.Job Posting TitleSr. Research Specialist - Bilingual (English-Spanish)Job DescriptionThe Senior Research Specialist is responsible for researching and resolving member complaints, determining resolution, and providing written communication to members and clients within established turnaround times. We are seeking bilingual (English-Spanish) candidates proficient in reading, speaking and writing.Responsibilities

Provide clients, members and pharmacies (Pharmacy Benefit Manager (PBM) Support Teams) with information regarding benefit plans to assure accurate claims processing and client/member satisfaction research

Utilize Prime’s internal systems to reply to questions and escalated issues from Prime’s internal and external partners in a timely manner and escalate or re-classify issues as appropriate

Communicate issue resolution results per standard operating procedures in a timely manner

Serve as a subject matter expert (SME), assisting with technical questions, workflow or process direction and coordinate peer letter review process

Collaborate with the supervisor to identify process and/or quality improvement opportunities and assist in the implementation of solutions and assist leadership with various projects as needed

Complete accurate reporting as needed/requested

Take member service and assist line calls as needed

Other duties as assigned

Minimum Qualifications

High School Diploma from an accredited school or equivalent GED

3 years of experience in Customer Service, Medicaid/Medicare benefit plans, or Grievances or Appeals

1 year of escalation resolution experience

Must be eligible to work in the United States without 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

Ability to make consistent and unbiased decisions

Strong verbal and written communication skills

Strong interpersonal communication skills, including conflict resolution and listening skills

Ability to work under strict timelines with while managing priorities simultaneously

Ability to maximize interdepartmental and client resources

Ability to exceed established Key Performance Indicators (KPIs)

Preferred Qualifications

Bilingual in English-Spanish

Associate’s or Bachelor’s degree in business, healthcare or related area of study, or equivalent combination of education and/or related work experience

Experience drafting professional correspondence

Certified Pharmacy Technician (CPhT) with pharmacy benefit management experience

Experience using internal systems

Healthcare experience, preferred pharmacy benefit management (PBM) and/or Government Programs (Medicare/Medicaid) experience

Minimum Physical Job Requirements

Constantly required to sit, use hands to handle or feel, talk and hear

Frequently required to reach with hands and arms

Occasionally required to stand, walk and stoop, kneel, and crouch

Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

Reports to a Manager or Supervisor in the Clinical Review Operations or Member Services department

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage qualified minority, female, veteran, disabled, and other diverse candidates to apply and be considered for open positions. Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage qualified minority, female, veteran, disabled, and other diverse candidates to apply and be considered for open positions. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email [email protected].

Vacancy caducado!

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