348 clinical consultant jobs found

The Senior RN Clinical Consultant will work in partnership with Clinical and Vocational Leaders to provide ongoing coaching and oversight to Clinical Consultants and will serve as clinical subject matter expert in all lines of business (STD/LTD/Appeals) and products, action planning management, and Guardian systems. This incumbent will have a strong clinical and client focus to assist in ensuring the fair and accurate assessments of medically supported functional abilities. They will assist in cultivating talent and foster an environment of continuous learning. They will promote organizational excellence by demonstrating leadership, problem-solving behaviors, and viewing challenges as opportunities. This individual will work with the Clinical Team Manager to drive performance and ensure the team meets their goals. They will effectively communicate & explain departmental initiatives and changes as they relate to organizational goals & strategies. They will assist the...

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...

When you join the team at Unum, you become part of an organization committed to helping you thrive. Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life’s moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide:  Award-winning culture  Inclusion and diversity as a priority  Performance Based Incentive Plans Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability  Generous PTO (including paid time to volunteer!)  Up to 9.5% 401(k) employer contribution  Mental health support  Career advancement opportunities  Student loan repayment options  Tuition reimbursement Flexible work environments  *All the benefits listed above are subject to the terms of their individual Plans. And that’s just...

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.   DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all....

Together we fight for everyone’s opportunity for a better financial future. We will do this together — with customers, partners and colleagues. We will fight for others, not against: We will stand up for and champion everyone’s access to opportunities. The status quo is not good enough … we believe every individual and every community deserves access to financial opportunities. We are determined to support both individuals and communities in reaching a better financial future.  We know that reaching this future depends on our actions today. Like our Purpose Statement, Voya believes in being bold and committed to action.  We are committed to a work environment where the differences that we are born with — and those we acquire throughout our lives — are understood, valued and intentionally pursued. We believe that our employees own our culture and have a responsibility to foster an environment where we all feel comfortable bringing our whole selves to work. Purposefully...

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. Brown & Brown   is seeking a   Lead Pharmacist to join our growing team! As a premier firm known for delivering exemplary services and solutions across diverse industries, we pride ourselves on our commitment to excellence, innovation, and a deep understanding of our clients' needs. As we continue to grow, we're hiring a Lead Pharmacist to lead our pharmacy strategy and consulting services. Position Overview: The Lead Pharmacist is a leadership role responsible for providing strategic, financial, and clinical consulting services across all pharmacy solutions. This role is ideal for a seasoned leader with proven experience in managing sophisticated pharmacy clients and driving sales goals. The position offers the flexibility to be an individual contributor or to lead a team of pharmacy consultants....

The Role: WTW is looking for an energetic individual with experience/expertise in activities relating to growth, pharmacy benefit management, growth, clinical pharmacy, and/or client facing roles to join our growing mid-market (MM) pharmacy team. As a MM-focused Pharmacy Consultant, you will be at the forefront of managing pharmacy benefits projects for clients and leveraging your experience as a pharmacy benefits expert to make recommendations on plan design and management. You will participate in new business activities and the creation of new intellectual capital.   You will position yourself to grow into a senior relationship management and/or leadership role by serving as the subject matter expert on pharmacy projects and working alongside industry experts on cutting-edge solutions. The ideal candidate is a client-centric problem solver who possesses the ability to balance member experience, financial considerations, client clinical/program needs and business growth. You...

A career at Auto-Owners is challenging and rewarding.  Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs. Job Description We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, this specific role could have the flexibility to work from home up to 3 days per week. Auto-Owners Insurance, a top-rated insurance carrier, is seeking motivated nursing professional to join our team. The position requires the person to: Collaborate with claims associates to provide medical expertise in the investigation, evaluation, and appropriate resolution of injury claims including workers’ compensation, personal injury protection (no fault), and liability. Evaluate medical records for relatedness to the injury and appropriate utilization of medical treatment and services. Prepare and deliver trainings to claims staff via a variety of modalities...

Join Westfield Specialty’s newest team!   Westfield Specialty’s new A&H team has an opening for joining our expanding operation. As a key contributor on this highly experienced team, you'll help build a premier A&H reinsurance and insurance operation. This new team offers significant opportunities for career growth and development.    The Senior Stop Loss Claims & Cost Containment Analyst  supports the Accident & Health (A&H) team by serving as a forward-facing liaison to cost containment vendors and customers while also providing hands-on support to stop loss and reinsurance claims operations. This role is responsible for coordinating cost containment strategies, assisting in claims production, and helping manage claims inventory and volume to ensure timely, accurate, and compliant claim outcomes. The position partners closely with internal claims staff, underwriting, reinsurance partners, and external vendors to drive consistency, efficiency,...

As part of our National Pharmacy Practice, the Region Pharmacy Consultant will serve as a strategic partner to our Market Leaders and their Producer and Client Management teams. This role acts as the pharmacy benefits subject matter expert; providing deep knowledge of the pharmacy space and a level of clinical independence to drive new client growth and increased retention. This individual will be responsible for consultative support, focusing on designated strategic size clients depending on the specific market. This role may work remotely but may require up to 50% travel. Major Responsibilities   Serves as a trusted advisor providing Pharmacy thought leadership for Employee Benefits at a regional level Drives sales and revenue growth by expanding current client relationships and new client opportunities in the mid and large employer market space through RFP participation, onsite or video presentation and one on one consultation Communicates strategic and tactical...

  The Role As a Compliance Consultant – Director, you will lead complex Health & Benefits compliance engagements while serving as a trusted advisor to large, sophisticated employers. You will provide strategic interpretation of federal and state regulations and translate evolving compliance requirements into practical, client-ready solutions. This role partners closely with Client Service Teams and other Communities of Expertise to embed compliance into broader benefit strategies and support the continued evolution of WTW’s compliance consulting capabilities.   Responsibilities Serve as lead consultant and trusted advisor on complex Health & Benefits compliance engagements Interpret and apply federal and state regulations (e.g., ACA, MHPAEA, HIPAA, IRC, ERISA, transparency) to client programs Anticipate emerging compliance risks and proactively advise clients on mitigation strategies Lead highly visible client engagements and major compliance workstreams...

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 As a Behavioral Health Consultant...

The Claim Consultant provides complete claim loss services for policyholders. This role will investigate, evaluate and dispose of MPL and General Liability claims with varying degrees of complexity and severity. The Claim Consultant works independently to provide claim-loss service for Coverys policyholders. This role will investigate and adjust claims with high levels of complexity and severity. Essential Duties & Responsibilities Interviews insureds, claimants, witnesses and other appropriate parties to obtain information used to assess liability exposure.  Documents related files regarding results of investigation and negotiations.  Prepares reports to file on established diary dates and other specific reports as needed to ensure timely file documentation and plan of action. Secures records for investigation and evaluation of cases. Determines and implements negotiation strategy and negotiates settlements within authority level....

Job Description: We are looking to add a Financial Consultant to join our Employee Benefits team in Dallas, TX . Offering a forward-thinking, innovative, and vibrant company culture, along with the opportunity to share your unique potential, there really is no place like Holmes! Essential Responsibilities: Runs and analyzes client monthly financial reporting (MFSR) and presents MFSRs to clients. Provides intermediate-level financial reporting and presents results to clients. Works independently and/or under senior team member's guidance to assist with client budget modeling as needed. Recommends basic strategic and tactical initiatives based upon clinical and financial data. Analyzes IBNR results with senior team member oversight. Attends client meetings with occasional day and overnight travel required. Articulates how emerging market conditions impact client health and welfare plans from a cost and clinical perspective. Articulates employee...

The Senior Stop Loss Consultant is a foundational member of our stop-loss consulting practice, responsible for leading day-to-day execution while contributing to the broader development of our team structure, workflows, and market positioning. This role combines individual execution and informal leadership responsibilities — including placement strategy, client consulting, team workflow oversight, and reimbursement resolution. The ideal candidate is a strong operator and subject matter expert, capable of managing a complex block of business while supporting the build-out of scalable stop-loss operations. Key Responsibilities: Placement & Renewal Management Lead or support the full stop-loss placement process: data collection, market submissions, quote analysis, and recommendation. Negotiate stop-loss contracts and renewals directly with carriers to ensure optimal pricing, terms, and coverage structures. Serve as a stop-loss lead on new business opportunities...

The Role: Willis Towers Watson is looking for an energetic individual with growth, pharmacy, clinical, and client-facing expertise to join our growing team. As an Associate Manager, Pharmacy Consulting, you will be at the forefront of managing pharmacy benefits projects for large, complex clients and leverage your experience as a pharmacy benefits expert to make recommendations on plan design and management. You will participate in new business activities and the creation of new intellectual capital. You will position yourself to grow into a consultant role by serving as the pivotal point on all projects and working alongside industry experts on cutting-edge solutions. The ideal candidate is a patient-centric problem solver who possesses the ability to balance client clinical needs and business growth. You will collaborate with a strong team of highly experienced consultants within the practice as well as engage in cross-functional activities.   Responsibilities: Provide...

The Care Advocate Nurse oversees initiatives surrounding assessing the severity of the injured workers’ reported injury(ies), reviews medical data in CareMC, validates and secures medical information, assesses and evaluates prescribed treatment of work related injury. The Care Advocate Nurse functions as a nurse consultant, supporting the goals of the Claims Management department and of CorVel. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Initiates and receives telephonic contact with reported injured worker, employer and medical providers to obtain treatment plan, secures medical documentation, and assesses if injured worker has returned to work Responsible for detailed documentation within the claim system focusing on medical condition, treatment plan and return to work status Directs callers to appropriate medical and/or claim resources Identifies and communicates urgent situations related to treatment or patient condition directly to the...

The Senior Claim Consultant provides complete claim loss services for policyholders.  Investigates, evaluates, and disposes of MPL and General Liability claims with varying degrees of complexity and severity.  Essential Duties & Responsibilities Interview insureds, claimants, witnesses, and other appropriate parties to obtain information used to assess liability exposure.  Document file regarding results of investigation and negotiations.  Prepare reports to file on established diary dates and other specific reports as needed to ensure timely file documentation and plan of action. Secure records for investigation and evaluation of cases. Determine and implement negotiation strategy and negotiates settlements within authority level. Adjust reserves within level of authority and make reserve recommendations to Manager/Director for amounts over position authority level. Evaluate cases for appropriate disposition and seek authority for settlement from...

Porch Group is a leading vertical software and insurance platform and is positioned to be the best partner to help homebuyers move, maintain, and fully protect their homes. We offer differentiated products and services, with homeowners insurance at the center of this relationship. We differentiate and look to win in the massive and growing homeowners insurance opportunity by 1) providing the best services for homebuyers, 2) led by advantaged underwriting in insurance, 3) to protect the whole home. As a leader in the home services software-as-a-service (“SaaS”) space, we’ve built deep relationships with approximately 30 thousand companies that are key to the...

Would you like to take ownership in a dynamic, high-growth business that truly walks the talk? Oswald Companies seeks goal-driven professionals ready to take their career to the next level. Job Summary : We are seeking an analytical and operationally focused Pharmacy Analyst to join our pharmacy consulting team. This role supports the operational, clerical, and compliance functions of the pharmacy department to ensure smooth, efficient, and accurate workflow. This role assists with documentation, scheduling, request for proposal coordination, data entry, and communication between pharmacy benefit managers, client service teams and our pharmacy consultant and clinical pharmacist. Responsibilities include maintaining paperwork, audit documentation, processing billing and invoicing information, and supporting pharmacy leadership with reporting and administrative projects. The ideal candidate is detail‑oriented, organized, and skilled in customer service, multitasking, and...