Manager, Pharmacy Operations

Hi, we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.

A Little More About The role:

We are looking for a Manager, Pharmacy Operations to play a critical role in the daily oversight of PBM functions and vendor relationships. This position focuses on operational execution, including claim review, audit support, reporting, and cross-functional collaboration to ensure accurate pharmacy benefit administration and a seamless member experience.

You will:

·       Review paid and rejected pharmacy claims daily to identify eligibility issues, benefit setup errors, or potential fraud, waste, and abuse (FW&A)

·       Monitor PBM FW&A reporting and coordinate findings with internal stakeholders for resolution or escalation

·       Track and support the PBM audit program, including documentation management and audit follow-ups

·       Manage day-to-day activities related to pharmacy vendor oversight, including billing reconciliation and performance guarantee tracking for pharmacy vendors.

·       Oversee pharmacy benefit and formulary configuration, testing, and validation of related reporting and output accuracy

·       Collaborate with the Marketing team to ensure member communications reflect timely and accurate pharmacy benefit and formulary updates

·       Perform quality reviews of Utilization Management (UM) and Prior Authorization (PA) cases and review reports to understand impacts to Gravie and our members.

·       Support internal stakeholders such as GravieCare, Sales, and Account Management by helping to troubleshoot and respond to pharmacy benefit inquiries

·       Work closely with the Director to continuously improve PBM processes, tools, and reporting

·       Demonstrate commitment to Gravie’s core values: being authentic, curious, creative, empathetic, and outcome-oriented

You bring: 

·       5+ years of experience in PBM operations, pharmacy claims, or health plan pharmacy departments

·       2+ years of experience in vendor management, claim auditing, or pharmacy benefits analysis

·       Familiarity with Medical Pharmacy claims (J-Codes, S-Codes, C-Codes) and formulary management

·       Strong analytical skills with a data-driven approach to solving operational problems

·       Excellent communication and collaboration skills across technical and non-technical teams

·       Proven ability to prioritize and manage multiple projects simultaneously

Extra credit: 

·       Previous work experience in a startup or high-growth company

Gravie: 

In order to transform health insurance and build a health plan everyone can love, we need talented people doing amazing work. In exchange, we offer a great overall employee experience with opportunities for career growth, meaningful mission-driven work, and an above average total rewards package.

The salary range for this position is $112,500 - $187,500 annually. Numerous factors including, but not limited to, educations, skills, work experience, certifications, etc. will be considered when determining compensation.

Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, cell phone reimbursement, transportation perks, education reimbursement, and 1 week of paid paw-ternity leave. 

A Little More About Us:

At Gravie, we're on a mission to reinvent health benefits for small and midsize businesses—making high-quality, affordable healthcare accessible to employers and their employees. We believe better benefits lead to better lives, and we’re building the future of health benefits to reflect just that.

We’re proud to be the only company offering both innovative level-funded health plans and a market-leading ICHRA solution, giving employers more choice and flexibility than ever before.

And guess what? Our customers love us. With member and employer satisfaction rates consistently trending above 80%, we know our health plans are working the way they should. Backed by some of the most sought-after investors in the country, we have the resources and long-term support to build something truly transformative—and we’re just getting started.

At Gravie, we do things differently. We’ll challenge you, and we’ll welcome you challenging us. Good ideas are everyone's job here. You’ll join a team that’s smart, mission-driven, and unafraid to push boundaries if it means making a bigger impact for the people we serve.

If you're energized by a high-performance, high-trust environment where your voice matters, Gravie might be just the place for you.