Senior Clinical Consultant, Health and Risk Solutions
Sun Life
full-time
Posted on:
Location Type: Hybrid
Location: Connecticut • Massachusetts • United States
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Salary
💰 $78,600 - $117,900 per year
Job Level
About the role
- Use technical expertise and clinical experience to coordinate with senior management, claims specialists, underwriting, sales team, and TPAs to review medical claims for appropriateness, identify cost savings opportunities, and assess potential risk.
- Investigate and negotiate medical and prescription charges, suggest care alternatives, and identify billing errors for potential cost savings opportunities.
- Review complex medical treatment plans for appropriateness and coverage, including treatments such as transplants, CAR-T therapies, and up-and-coming gene therapies.
- Create and facilitate educational presentations for a variety of internal and external audiences.
Requirements
- Active Registered Nurse license
- 5+ years of clinical nursing experience is required
- Prior Stop Loss insurance experience or 3+ years of Medical in-depth case management experience preferred
- Excellent working knowledge of current medical conditions and treatment plans, including but not limited to an understanding of organ and tissue transplantation, oncology, cardiac or other critical illness
Benefits
- generous vacation and sick time
- market-leading paid family, parental and adoption leave
- medical coverage
- company paid life and AD&D insurance
- disability programs
- partially paid sabbatical program
- 401(k) employer match
- stock purchase options
- employer-funded retirement account
- flexible, inclusive and collaborative work environment that supports career growth
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical nursingmedical claims reviewcost savings analysisrisk assessmentnegotiationbilling error identificationmedical treatment plan reviewtransplantationCAR-T therapiesgene therapies
Soft Skills
communicationpresentation skillscoordinationinvestigative skillsproblem-solving
Certifications
Registered Nurse license