Senior Clinical Consultant, Health and Risk Solutions
Stryker Corporation, Hartford, CT, United States
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.
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.
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.
Qualifications
Ability to work with a diverse range of people.
Active Registered Nurse license.
5+ years of clinical nursing experience (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 an understanding of organ and tissue transplantation, oncology, cardiac or other critical illness.
Salary Range
$78,600 - $117,900
EEO and Accommodation Statement
We will make reasonable accommodations to the known physical or mental limitations of otherwise‑qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Posting End Date: 31/05/2026
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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.
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.
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.
Qualifications
Ability to work with a diverse range of people.
Active Registered Nurse license.
5+ years of clinical nursing experience (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 an understanding of organ and tissue transplantation, oncology, cardiac or other critical illness.
Salary Range
$78,600 - $117,900
EEO and Accommodation Statement
We will make reasonable accommodations to the known physical or mental limitations of otherwise‑qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Posting End Date: 31/05/2026
#J-18808-Ljbffr