Qureos Mentor

Prime Therapeutics

<div><div>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.</div><div>
Job Posting Title</div><div></div>
Senior Business Analyst - Medicaid Implementations - Remote<div>
Job Description</div><div></div>
The Business Analyst (BA) Senior will execute on medium projects as a liaison among business operations, technology groups, clients, business partners, vendors, and project/program team to understand, analyze, and facilitate business needs, requirements, and impacts of business changes as a result of strategic initiatives, operational changes, compliance requirements, client needs, and technology or operational improvements. Additionally, this role will participate with leadership and/or the Center of Excellence to define and implement the best practice activities for Business Analysis.<div></div><div>
Responsibilities</div><ul><li>
Execute independently on medium sized projects or as part of a team of BAs on large sized or complex projects working closely with internal and external stakeholders to ensure superior customer and client experience</li><li>
Define and validate business needs with project team</li><li>
Participate in stakeholder analysis and identify subject matter experts needed for work effort</li><li>
Assess capability gaps, determine solution options and approach, and define solution scope</li><li>
Plan overall business analysis approach and activities for projects including user acceptance testing</li><li>
Prepare for, conduct, and document elicitation sessions</li><li>
Manage requirements traceability to solution scope, objectives, system requirements, and testing</li><li>
Adherence to business analysis discipline and standards in accordance with the Prime Project Lifecycle methodology</li><li>
Other duties as assigned</li></ul><div></div><div>
Minimum Qualifications</div><ul><li>
Bachelor's degree in business, IT, or related area of study, or equivalent combination of education and/or relevant work experience; High School Diploma or GED equivalent required</li></ul><ul><li>
5 years of work experience in business analysis</li></ul><div></div><div>
Must be eligible to work in the United States without the need for work visa or residency sponsorship</div><div></div><div>
Additional Qualifications</div><ul><li>
Advanced understanding of business analysis concepts and methodologies</li><li>
Demonstrated drive to deliver result</li><li>
Demonstrated verbal, written communication, facilitation skills, conflict management, consensus building, problem solving, analytical skills, and creative thinking skills</li><li>
Ability to organize and prioritize multiple tasks with high degree of attention to detail</li><li>
Self-directed and strong personal initiative and accountability</li><li>
Team player, comfortable with fast paced, changing environment and ambiguity</li><li>
Experience in leading and motivating diverse project teams to achieve stated results</li><li>
Ability to independently deliver against all job accountabilities</li><li>
Desire to educate and advance the BA practice across the organization</li></ul><div></div><div>
Preferred Qualifications</div><ul><li>
Advanced knowledge of the Business Analysis Body of Knowledge (BABOK)</li><li>
Experience in client relationship management</li><li>
Completion of a Business Analysis certification</li><li>
Demonstrated experience in business analysis on large complex projects or varying project types</li><li>
Deep knowledge of business analysis tasks, activities, techniques, and requirements process</li><li>
Expert in basic office productivity software and tools (MS Word, Excel, Visio, etc.)</li><li>
Experience in Pharmacy Benefit Management (PBM) or healthcare industry</li></ul><div></div><div>
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures</div><div></div><div><br>
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.</div><div></div>
Potential pay for this position ranges from $81,000.00 - $138,000.00 based on experience and skills.<div></div><div><i><br>
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.</i></div><div></div><div><i>
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.</i></div><div></div><div><i>
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.</i></div><div></div><div>
Positions will be posted for a minimum of five consecutive workdays.</div></div>

Senior Business Analyst - Medicaid Implementations - Remote

<div><div>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.</div><div>
Job Posting Title</div><div></div>
Eligibility Analyst<div>
Job Description</div><div></div>
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.<div></div><div>
Responsibilities</div><ul><li>
Serves as subject matter expert representing eligibility on file process for new and existing clients and 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</li><li>
Serves as primary contact for external clients, vendors and Prime's Client Engagement team for requests and escalated issues; responsible for facilitating timely resolution</li><li>
Identifies and implements improvements for existing Eligibility processes</li><li>
Participates in peak season planning and execution</li><li>
May manage Medicaid subrogation activities including monitoring batch claim files, outgoing eligibility files, verification of letters of authority and some claims analysis.</li><li>
Other duties as assigned</li></ul><div></div><div>
Minimum Qualifications</div><ul><li>
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</li></ul><ul><li>
2 years of experience in healthcare, PBM, Eligibility or claims processing</li><li>
Must be eligible to work in the United States without need for work visa or residency sponsorship</li></ul><div></div><div>
Must be eligible to work in the United States without the need for work visa or residency sponsorship</div><div></div><div>
Additional Qualifications</div><ul><li>
Ability to work in a collaborative team based environment</li><li>
Strong oral and written communication skills</li><li>
Strong organizational and time management skills</li><li>
Problem solving skills with strong attention to detail</li><li>
Ability to implement defined objectives and to act independently</li></ul><div></div><div>
Preferred Qualifications</div><ul><li>
Previous PBM Experience</li><li>
Experience working in eligibility or enrollment</li><li>
Experience with Microsoft Excel</li></ul><div></div><div>
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures</div><div></div><div><br>
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.</div><div></div>
Potential pay for this position ranges from $53,000.00 - $85,000.00 based on experience and skills.<div></div><div><i><br>
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.</i></div><div></div><div><i>
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.</i></div><div></div><div><i>
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.</i></div><div></div><div>
Positions will be posted for a minimum of five consecutive workdays.</div></div>

Eligibility Analyst

<div><div>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.</div><div>
Job Posting Title</div><div></div>
Director, Compliance (Regulatory)<div>
Job Description</div><div></div><div>
The Director of Compliance is responsible for the successful development, implementation and execution of Prime&rsquo;s compliance program. This position is accountable for advising and consulting with business area leadership in the execution of the program and associated work plan within a given business area.</div><div></div><div>
Responsibilities</div><ul><li>
Manages a team of experienced compliance managers</li><li>
Provides consultation to internal and external leaders regarding escalated legal and compliance issues, regulatory and client audits; serves as primary contact for assigned internal business leaders and clients</li><li>
Responsible for ensuring operating areas are in compliance with regulatory requirements; ensures that all appropriate local, state, and federal regulations are followed</li><li>
Provides compliance advice, investigates complaints and verifies deficiencies are corrected; oversees CAP management and findings</li><li>
Consults on regulatory change management process and program and advises on areas of organizational risk</li><li>
Supports the Chief Compliance Officer&rsquo;s reporting to the Corporate Compliance Committee and the Compliance and Audit Committee</li><li>
Promotes awareness and communication of compliance and ethics</li><li>
Other duties as assigned</li></ul><div></div><div>
Minimum Qualifications</div><ul><li>
Bachelor&rsquo;s degree in business or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required</li></ul><ul><li>
8 years of work experience in legal, compliance, or related field</li><li>
5 years of leadership/people management experience</li><li>
Must be eligible to work in the United States without need for work visa or residency sponsorship</li></ul><div></div><div>
Must be eligible to work in the United States without the need for work visa or residency sponsorship</div><div></div><div>
Additional Qualifications</div><ul><li>
Demonstrated frequent use of and general knowledge of industry practices, techniques, and standards</li><li>
Communicates effectively through both verbal and written communication</li><li>
Demonstrated ability to organize and structure work to focus on the areas of most importance</li><li>
Works effectively with others in different functions or groups</li></ul><div></div><div>
Preferred Qualifications</div><ul><li>
Advanced degree in a relevant discipline (JD, MBA, MHA, etc.)</li><li>
PBM/health care experience</li></ul><div></div><div>
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures</div><div></div><div>
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.</div><div>
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Potential pay for this position ranges from $108,000.00 - $184,000.00 based on experience and skills.<div></div><div><i><br>
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.</i></div><div></div><div><i>
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.</i></div><div></div><div><i>
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.</i></div><div></div><div>
Positions will be posted for a minimum of five consecutive workdays.</div></div>

Director, Compliance (Regulatory)

<div><div>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.</div><div>
Job Posting Title</div><div></div>
Claim Technical Analyst - JUDI Ops Team - Remote<div>
Job Description</div><div></div><div>
The Claims Technical Analyst is responsible for serving as the claims analysis resource for an assigned operations team. This role is responsible for developing queries to retrieve data and performing intermediate level and some complex client, member and pharmacy remediation analysis caused by errors coded into the JUDI claims processing system. This position also researches and tests system capabilities.</div><div></div><div>
Responsibilities</div><ul><li>
Develop and perform complex queries to retrieve data for required analysis</li><li>
Research and analyze information by employing more advanced analytics and data science techniques to research and validate errors, isolate impacted claims, reprocess claims, and determine financial impact to members, health plans and/or pharmacies; translate complex data into usable client facing reports</li><li>
Research, test, and respond to inquiries regarding JUDI system capabilities; update department documentation with information gained from research</li><li>
Identify and participate in implementing department level process improvements</li><li>
Other duties as assigned</li></ul><div></div><div>
Minimum Qualifications</div><ul><li>
Bachelor's degree in business, Computer Science, IT, Mathematics, Finance or related area of study; or equivalent combination of education and/or relevant work experience; HS diploma or GED required</li><li>
2 years of work experience in data analysis, in the healthcare, insurance, finance or related industry</li><li>
Must be eligible to work in the United States without need for work visa or residency sponsorship</li></ul><div></div><div>
Additional Qualifications</div><ul><li>
Strong verbal and written communication skills</li><li>
Advanced reporting skills</li><li>
Running manual processes</li><li>
Ability to coordinate multiple projects/tasks simultaneously under strict timelines</li><li>
Strong analytical, problem solving, and decision-making skills</li><li>
Ability to work in fast-paced, collaborative team environment</li><li>
Intermediate level Microsoft Excel Analysis Skills</li><li>
Ability to present complex material to a variety of audiences in plain language</li><li>
Strong negotiation and persuasion skills</li><li>
Experience utilizing query tools and Structured Query Language (SQL)</li></ul><div></div><div>
Preferred Qualifications</div><ul><li>
Experience with Medicare Part D and Centers for Medicare and Medicaid Services rules and regulations</li><li>
1 year of experience working with claims systems</li></ul><div></div><div>
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures</div><div></div><div>
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.</div><div></div>
Potential pay for this position ranges from $59,000.00 - $94,000.00 based on experience and skills.<div></div><div><i><br>
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.</i></div><div></div><div><i>
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.</i></div><div></div><div><i>
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.</i></div><div></div><div>
Positions will be posted for a minimum of five consecutive workdays.</div></div>

Claim Technical Analyst - JUDI Ops Team - Remote

<div><div>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.</div><div>
Job Posting Title</div><div></div>
Claims Specialist Sr<div>
Job Description</div><div></div>
The Claims Specialist is responsible for assisting in the ongoing operational support of Prime key service offerings. This position is responsible for responding to inquires from internal and external partners for the research of and resolution of claim issues. Additionally, this position serves as a subject matter expert resource for coworkers and other departments.<div></div><div>
Responsibilities</div><ul><li>
Work in Medicare, Commercial and Health Insurance Marketplace (HIM) integrity lines of business to ensure strict adherence to unique guidelines and regulations for each</li><li>
Monitor and respond appropriately to incoming inquiries related to specific process or support systems (e.g. claim adjudication system) Escalate issues when appropriate</li><li>
Partner with Prime's clients to produce and execute corrective measures found in key service offerings</li><li>
Process authorizations to meet HIPAA/privacy and CMS requirements</li><li>
Sorts, researches and processes daily internal and external documents received by the mailroom.</li><li>
Assist with RxClaim Release user acceptance testing and reporting</li><li>
Serve as a subject matter expert (SME) resource for other departments</li><li>
Other duties as assigned</li></ul><div></div><div>
Minimum Qualifications</div><ul><li>
High school diploma from accredited institution or equivalent GED</li></ul><ul><li>
1 year of claims experience</li><li>
Must be eligible to work in the United States without need for work visa or residency sponsorship</li></ul><div></div><div>
Must be eligible to work in the United States without the need for work visa or residency sponsorship</div><div></div><div>
Additional Qualifications</div><ul><li>
Experience with Microsoft Office products</li><li>
Strong written and verbal communication skills</li><li>
Strong organizational skills</li><li>
Ability to work independently</li><li>
Strong attention to detail with ability to perform with high degree of accuracy</li><li>
Ability to prioritize and handle multiple tasks simultaneously</li></ul><div></div><div>
Preferred Qualifications</div><ul><li>
2+ years of experience in claims, insurance, or healthcare</li><li>
Extensive experience using Excel spreadsheets</li></ul><div></div><div>
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures</div><div></div><div><br>
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.</div><div></div>
Potential pay for this position ranges from $19.23 - $28.85 based on experience and skills.<div></div><div><i><br>
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.</i></div><div></div><div><i>
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.</i></div><div></div><div><i>
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.</i></div><div></div><div>
Positions will be posted for a minimum of five consecutive workdays.</div></div>

Claims Specialist Sr

<div><div>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.</div><div>
Job Posting Title</div><div></div>
Claims Analyst - JUDI Ops Support - Remote<div>
Job Description</div><div></div><div>
The Claims Analyst is responsible for serving as a Claims Operations subject matter expert on system functionality which may include implementations, projects, and testing for key Prime service offerings. This position is responsible for working with internal and external clients and serving as an escalation and mentoring resource on production issues.</div><div></div><div>
Responsibilities</div><ul><li>
Represent Claim Operations as subject matter expert (SME) on both internal and external projects, participating in all relevant functions on project lifecycle</li><li>
Identify, analyze, and implement system and process improvements using variety of personnel and data resources</li><li>
Translate complex details of system capabilities, enhancements, and implementations to non-technical resources, serving as main resource for department on training and documentation of new projects/processes</li><li>
Partner with Prime's Clients to identify, problem solve, and execute corrective measures</li><li>
Provide backup support to various roles within department with ability to serve as short-term stand-in for each position, when necessary</li><li>
Other duties as assigned</li></ul><div></div><div>
Minimum Qualifications</div><ul><li>
Bachelor's degree in IT, Business, Science or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required</li><li>
2 years of work experience in claims processing or project lifecycle, or related roles in the healthcare or PBM industry</li><li>
Must be eligible to work in the United States without need for work visa or residency sponsorship</li></ul><div></div><div>
Additional Qualifications</div><ul><li>
Experience with Microsoft Office products</li><li>
Knowledge of how claims are paid</li><li>
Ability to work in fast paced, collaborative, team environment under strict deadlines</li><li>
Flexibility in job duties with ability to work on multiple tasks simultaneously</li><li>
Strong verbal, written, and interpersonal communication skills</li><li>
Strong analytical, organizational, time management, and problem-solving skills</li><li>
Strong attention to detail</li></ul><div></div><div>
Preferred Qualifications</div><ul><li>
PBM industry knowledge</li><li>
2 years of experience working with RxClaim</li><li>
Work cross functionally with other departments/clients</li><li>
Excel</li></ul><div></div><div>
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures</div><div></div><div>
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.</div><div></div>
Potential pay for this position ranges from $59,000.00 - $94,000.00 based on experience and skills.<div></div><div><i><br>
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.</i></div><div></div><div><i>
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.</i></div><div></div><div><i>
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.</i></div><div></div><div>
Positions will be posted for a minimum of five consecutive workdays.</div></div>

Claims Analyst - JUDI Ops Support - Remote

Join Prime Therapeutics and explore 6   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.