GPRT Research Specialist Lead

GPRT Research Specialist Lead

The Lead Research Specialist position is responsible for researching and resolving complex and escalated member issues while ensuring accurate, timely, and compliant outcomes. This role 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. It also contributes to reporting, process improvements, and operational support to help meet service levels and performance expectations.

• 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

• High School diploma from an accredited school or equivalent GED
• 4 years of work experience in customer service, benefit plans, grievances or appeals

• 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

• 2 years of escalation resolution experience
• Experience drafting professional correspondence
• Prior healthcare and/or government programs (Medicare/Medicaid) experience

Potential pay for this position ranges from $21.15 to $31.73 per hour based on experience and skills.

Equal Opportunity and affirmative action employer: Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. 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 with a range of backgrounds, experiences, abilities, and perspectives, including qualified applicants with arrest and conviction records and those requiring reasonable accommodations.

Reasonable accommodation: 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 .

Prime Therapeutics LLC is a Tobacco‑Free Workplace employer.