Senior Clinical Consultant, Health and Risk Solutions

Sun Life • Wellesley, MA

1d • Hybrid

About The Position

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our team members and leaders are expected to foster connection and teamwork by being present in the office at least 2 days per week. The opportunity: In the Senior Clinical Risk Consultant role, you will use prior medical knowledge and research capabilities to help individuals understand what medical treatments are needed, or may be needed in the future, and determine what treatments would cost. You will use your extensive knowledge, medical expertise, and professional experience to review claims, underwriting prospects and renewals to recommend the best possible care, for an appropriate cost, in the best possible setting. This position requires an understanding of medical insurance and is non-patient facing.

Requirements

• Ability to work with a diverse range of people
• 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
• A passion for helping people, especially in times of need due to illness or injury
• Your desire and ability to provide superior service and build and maintain positive relationships
• Independent analytical thinking, organizational, and decision-making skills.
• 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

Nice To Haves

• Prior Stop Loss insurance experience or 3+ years of Medical in-depth case management experience preferred

Responsibilities

• 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.

Benefits

• At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.
• Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account.
• Enjoy a flexible, inclusive and collaborative work environment that supports career growth.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed
• Number of Employees: 1-10 employees