Employee Benefits Clinical Consultant

Hub International Insurance•Metairie, LA

About The Position

The Clinical Consultant brings a clinical perspective to employee benefits consulting. Working alongside account teams and other internal specialty partners, the clinical consultant leverages their specialized knowledge base while reviewing claims and utilization data to identify patterns in health trends, large claimant treatments, quality of care, population health and cost. Ultimately translating clinical findings and observations into clear, actionable insight that supports client strategy and decision-making.

Requirements

Bachelor's degree in a health-related field required; BSN active RN license preferred
Associate-level Registered Nurse (RN) or Licensed Practical/Vocational Nurse (LPN/LVN) with an active license and relevant clinical experience will be considered in lieu of a bachelor's degree.
Two (2) to five (5) years of direct patient care or clinical practice experience is required.
Proficient in Microsoft Office products (Excel, PowerPoint, Word, etc.).
Strong written and verbal communication skills
Strong organizational and time-management skills, with the ability to prioritize a varied workload and manage day-to-day responsibilities with minimal oversight.

Responsibilities

Reviews and interprets medical and pharmacy claims data, applying clinical knowledge of disease states, treatment protocols, and pharmacology to identify utilization patterns, cost drivers, and gaps in care.
Learns and adapts to new reporting and technology tools as needed to support client deliverables.
Provides condition interpretation and risk education, explaining how identified conditions may affect plan risk and cost trajectory, grounded in standards of care and medical necessity.
Reviews clinical risk factors and treatment patterns among large or complex claimants, identifying key cost and risk drivers that support account team discussion.
Identifies utilization patterns behind emergency room visits, hospital admissions, and specialty drug or site-of-care opportunities, distinguishing clinically necessary care from avoidable utilization.
Shares clinical interpretation with the account team and other specialty partners to support broader population health and plan strategy discussions.
Supports account team preparation for carrier conversations by identifying clinical patterns in carrier and vendor program data; may participate directly in carrier discussions as directed.
Prepares clinical deliverables for routing to account team or presents directly on client calls as assigned.
Maintains current knowledge of emerging treatment drug and site of care trends relevant to plan cost and utilization through ongoing research, training, and professional development.
Maintains strict compliance with applicable regulatory and compliance standards including HIPAA, PHI protections, state and federal regulations, company policies, and client confidentiality standards.
Other duties as assigned.