429 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....

Foundation Risk Partners , one of the fastest growing insurance brokerage and consulting firms in the US, is adding a Clinical Risk Management Consultabt to their  Cornell Insurance Services  team in the Edison, NJ office.  Job Summary: The Clinical Risk Management Consultant is focused on identifying, assessing, and mitigating clinical risks for healthcare providers within an insurance brokerage firm, utilizing their medical expertise to analyze potential claims, advise clients on risk reduction strategies, and work with underwriters to secure appropriate coverage based on clinical risk factors.  Essential Functions: Clinical Risk Assessment: Review medical records, incident reports, and claims data to identify potential clinical risks associated with patient care, including medication errors, standard of care compliance risks, and diagnostic errors. Detect and manage risk exposure Maintain and update an organization's policies...

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...

Job Description ABOUT US At HUB International, we are a team of entrepreneurs. We believe in protecting and supporting the aspirations of individuals, families, and businesses. We help our clients evaluate their risks and develop solutions tailored to their needs. We believe in empowering our employees to learn, grow, and make a difference. Our structure enables our teams to maintain their own unique, regional culture while leveraging support and resources from our corporate centers of excellence. HUB is a global insurance and employee benefits broker, providing a boundaryless array of business insurance, employee benefits, risk services, personal insurance, retirement, and private wealth management products and services. With over $5 billion in revenue and almost 20,000 employees in 600 offices throughout North America, HUB has grown substantially, in part due to our industry leading success in mergers and acquisitions. ABOUT THE ROLE The Actuarial...

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....

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology. Join us in improving health care outcomes for all!  We promise to do what’s right, always. Position Summary: The Pricing Manager will be responsible for managing pricing and underwriting processes in support of business development efforts.  They will have a thorough understanding of PBM pricing intricacies, financial modeling, and data analysis.  The ideal candidate will have experience in development and execution of PBM competitive bidding, guarantee setting, rebate projections, ad-hoc analysis, and narrating pricing related...

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,...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Disability Clinical Team Lead PRIMARY PURPOSE :  To supervise the operation of Disability Clinical Consultants for disability clients; to monitor colleagues’ workload, provide training and monitor individual claim activities; to provide clinical direction to Disability Clinical Consultants; and to review complex cases as appropriate. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Acts as clinical liaison for the claims team to ensure understanding of the Nurse...

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...

For over 30 years PSG has been singularly focused on helping our clients navigate the complex and ever-changing challenges of drug management. Through our leading pharmacy intelligence and technologies, we save our clients billions of dollars every year with an unwavering commitment to serving as a strong industry advocate and strategic partner. PSG has market leading technology and administration services for plan sponsors, employers, unions and trusts, hospitals, and health systems. Our mission is to relentlessly advocate for our clients as we partner together to develop innovative drug management solutions that deliver exceptional strategic insights, financial and clinical value. As a Senior Pharmacy Benefit Consultant, you will serve as the primary/lead consultant on strategic clients. You will lead and cultivate multi-level client relationships with executives, human resource personnel, pharmacy department personnel and others which enable PSG to partner with clients to...

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...