Eligibility Analyst (Remote)

 

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.

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Job Posting Title

Eligibility Analyst (Remote)

Job Description

The Eligibility Analyst is responsible for representing commercial or government programs’ eligibility and acts as a subject matter expert for department projects, Run functions and escalated client issues. This role is responsible for mentoring and training the Eligibility Specialist.

Responsibilities

• Serves as subject matter expert representing eligibility on file process for new and existing clients, department projects,; monitors eligibility mailbox and Prime Resolution daily, participates in workstream meetings, assists with providing information regarding business requirements, and performs User Acceptance Testing
• Serves as primary contact for external clients and Prime’s Client Engagement team for requests and escalated issues; responsible for facilitating timely resolution
• Identifies and implements improvements for existing Eligibility processes
• Participates in peak season planning and execution
• Other duties as assigned

Minimum Qualifications

• Bachelor’s degree in IT, Business, Liberal Arts, Science or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED required
• 2 years experience in healthcare, PBM, Eligibility or claims processing
• Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

• Ability to work in a collaborative team based environment
• Strong oral and written communication skills
• Strong organizational and time management skills
• Problem solving skills with strong attention to detail
• Ability to implement defined objectives and to act independently

Preferred Qualifications

• Previous PBM Experience
• Experience working in eligibility or enrollment
• Experience with Microsoft Excel
• Experience with Medicaid Subrogation

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
• Ability to work a flexible schedule including weekends, holidays, overtime, on call, and shifts outside of Prime’s core business hours of 9:00 a.m. to 3:00 p.m.

Reporting Structure

• Reports to a Supervisor or Manager in the PBM Operations department

Potential pay for this position ranges from $56,500.00 - $85,100.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

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