Eligibility Analyst- REMOTE

Rhode Island Staffing; Providence (RI); Remote; USD 53,000 - 85,000; Full time

Job summary

Rhode Island Staffing seeks a dedicated Eligibility Analyst to work remotely. The ideal candidate will serve as a subject matter expert and have a strong background in healthcare or claims processing.

With responsibilities ranging from monitoring eligibility processes to mentoring specialists, this role requires excellent communication and organizational skills. The position offers a salary between $53,000 and $85,000 based on experience and skills.

Qualifications

• At least 2 years of experience in healthcare, PBM, eligibility, or claims processing.
• Eligibility to work in the United States without requiring a work visa or residency sponsorship.

Responsibilities

• Serve as subject matter expert for eligibility on file processes.
• Monitor eligibility mailbox and assist with business requirements.
• Facilitate timely resolution of eligibility issues.

Skills

Team collaboration

Communication skills

Organizational skills

Problem-solving skills

Education

Bachelor’s degree in IT, Business, Liberal Arts, Science, or related field

High school diploma or GED

Tools

Microsoft Excel

Job description

Eligibility Analyst – Remote

Prime Therapeutics (Prime) is a pharmacy benefits manager dedicated to connecting care for those we serve. We are looking for a purpose‑driven professional to join our team.

Responsibilities

• Serve as subject matter expert for eligibility on file processes for new and existing clients and department projects.
• Monitor the eligibility mailbox and Prime Resolution daily, participate in workstream meetings, and assist with providing information regarding business requirements.
• Perform user acceptance testing and serve as the primary contact for external clients, vendors, and Prime’s Client Engagement team for requests and escalated issues.
• Facilitate timely resolution of eligibility issues and identify and implement improvements for existing eligibility processes.
• Participate in peak season planning and execution.
• May manage Medicaid subrogation activities, including monitoring batch claim files, outgoing eligibility files, verification of letters of authority, and some claims analysis.
• Mentor and train Eligibility Specialists and perform other duties as assigned.

Minimum Qualifications

• Bachelor’s degree in IT, Business, Liberal Arts, Science, or related field, or equivalent combination of education and relevant work experience.
• High school diploma or GED required.
• At least 2 years of experience in healthcare, PBM, eligibility, or claims processing.
• Eligibility to work in the United States without requiring a work visa or residency sponsorship.

Additional Qualifications

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

Preferred Qualifications

• Previous PBM experience.
• Experience in eligibility or enrollment.
• Proficiency with Microsoft Excel.

Additional Information

Each employee must understand, comply with, and attest to the security responsibilities and controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Each 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.

Prime may change or assign other duties to this job.

Potential pay for this position ranges from $53,000.00 to $85,000.00 based on experience and skills.

Equal Employment Opportunity Statement

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.