Full-Time
Pharmacy Member Specialist
Posted on 8/19/2024
Gravie
201-500 employees
Health benefits and insurance solutions provider
Mid
Minneapolis, MN, USA
- 3 + years of Retail, Mail Order, or specialty pharmacy experience, preferably with patient escalation issues, or equivalent experience in a similar setting.
- Experience working with cross functional teams to understand business strategy and implement defined processes.
- Fact-based problem solver with the ability to evaluate alternative courses of action and make sound engagement decisions.
- Ability to multitask and deal with ambiguity.
- Relentless focus on the member experience.
- Provide support to Gravie’s Clinical team in relation to pharmacy needs including Home Infusion, Musculoskeletal program support, specialty savings programs, and more.
- Help facilitate both provider and member outreach campaigns.
- Address inquiries related to coverage, medication management, prior authorizations, specialty savings programs, pharmacy networks, and more.
- Investigate and resolve pharmacy claims issues by working with the claims team and Gravie’s PBM to ensure accurate processing and payments.
- Provide education to members about their pharmacy benefits and covered formulary options, as well as cost saving opportunities and medication adherence strategies.
- Identify areas for process improvement and contribute to the development of the department to enhance pharmacy benefit services.
- Support internal teams, including operations, sales, brokers, account management, customer care, clinical operations with questions and issues related to pharmacy care to deliver a seamless member experience.
- Other duties as assigned.
Gravie provides health benefits by offering straightforward and affordable health plans, primarily targeting individuals and small to midsize businesses. Their main product, Comfort, stands out because it has no deductible and no copays for most common healthcare services, allowing members to access care without unexpected costs. Additionally, Comfort includes virtual care options for musculoskeletal and mental health issues. Gravie also offers a payment solution called Gravie Pay, which enables members to pay for healthcare expenses interest-free, further easing financial stress. Unlike traditional health plans, Gravie claims that Comfort members save on out-of-pocket costs, and employers switching to Gravie often see lower premium expenses. The company has a high retention rate, indicating that many employees choose to continue with the Comfort plan in subsequent years. Gravie's goal is to simplify health benefits and reduce the financial burden of healthcare for its members.
Company Stage
Series E
Total Funding
$342.6M
Headquarters
Minneapolis, Minnesota
Founded
2013
6 month growth
↑ 4%1 year growth
↑ 28%2 year growth
↑ 101%
Simplify's Take
What believers are saying
- Gravie's recent $179 million equity investment from General Atlantic and others indicates strong financial backing and growth potential.
- The high retention rate and reported cost savings for both employers and employees suggest a highly satisfied customer base.
- The addition of experienced executives like Ken Paulus and Andrew Reeves to the board and leadership team strengthens Gravie's strategic direction and industry expertise.
What critics are saying
- The health insurance market is highly competitive, and Gravie must continuously innovate to maintain its edge.
- The company's rapid growth and numerous new hires could lead to integration challenges and potential operational inefficiencies.
What makes Gravie unique
- Gravie's Comfort plan eliminates deductibles and copays for most common healthcare services, a stark contrast to traditional health plans.
- The inclusion of virtual musculoskeletal and mental health care services sets Gravie apart in the health benefits market.
- Gravie Pay offers an interest-free payment solution, further reducing the financial burden on members, unlike many competitors.