Senior Clinical Consultant, Health and Risk Solutions

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.  

Job Description:

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.

How you will contribute:

·         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.

What you will bring with you:

·         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

Salary Range: $78,600 - $117,900
At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

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