Eligibility Specialist Sr

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Eligibility Specialist Sr

Job Description

The Senior Eligibility Specialist ensures the accurate and timely processing of eligibility data for Commercial Markets and Government Programs. This position supports both internal and external stakeholders by resolving moderately complex eligibility issues, maintaining data accuracy, and contributing to process improvement initiatives. This role works under general supervision and supports operational excellence through detailed data validation, adherence to regulatory requirements, and partnership with senior team members to troubleshoot eligibility discrepancies.

Responsibilities

• Review, validate, and process eligibility files and enrollment data in accordance with established procedures and timelines

• Investigate and resolve moderately complex eligibility issues and customer inquiries, escalating as needed to senior staff or leadership

• Identify and document errors, trends, and inefficiencies within eligibility data to support continuous process improvements

• Ensure compliance with applicable contractual, regulatory, and internal requirements, maintaining confidentiality and data integrity

• Support audit preparation and respond to data-related inquiries from internal stakeholders and external partners

• Other duties as assigned

Minimum Qualifications

• High school diploma from an accredited school or equivalent GED

• 2 years of experience in eligibility, enrollment, PBM, or related healthcare administration

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Strong attention to detail and organizational skills with the ability to manage competing priorities

• Excellent written and verbal communication skills for internal and external interactions

• Ability to analyze and resolve moderately complex issues with minimal supervision

• High degree of accuracy and accountability in data management

• Demonstrated ability to work effectively in a team-oriented and collaborative environment

Preferred Qualifications

• Experience with eligibility or enrollment platforms and large-scale data management systems

• Proficiency with Microsoft 365 applications, including Excel and Outlook preferred

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

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.

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

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page ( and click on the "Benefits at a glance" button for more detail (

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 (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. _?

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.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer._

Positions will be posted for a minimum of five consecutive workdays.

At Prime Therapeutics (Prime), we are a different kind of PBM. We're reimagining pharmacy solutions to provide the care we would want for our loved ones. That purpose energizes our team and creates limitless opportunities to make a difference.

We know that people make all the difference. If you're ready for a purpose-driven career and are passionate about simplifying health care, let's build the future of pharmacy together.

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 (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. ?? ?

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.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

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].