479 clinical consultant jobs found

Principal Duties and Responsibilities Ensure effective risk management.  Perform reviews, assessment of new business, and renewal large claims/disclosure to identify known and potential risk. Assist underwriters in the evaluation and assessment of clinical and claims data to identify and quantify known and potential risk through the provision of concise, detailed, and accurate reporting of data analysis findings, observations and recommendations to underwriting. Effectively explain complex clinical conditions to team. Develop and maintain strong client, TPA and vendor relationships. Consult with clients and TPA’s on case management issues, alternative levels of care, program development, quality improvement, claims issues and educational needs. Work with claim team to determine the need to impact, develop a cost mitigation strategy and work with internal as well as external stakeholders to produce an effective clinical and financial outcome. Assist with medical...

Company: Marsh McLennan Agency Description: Clinical Consultant – Employee Health & Benefits Our not-so-secret sauce. Award-winning, inclusive, Top Workplace culture doesn’t happen overnight. It’s a result of hard work by extraordinary people. The industry’s brightest talent drives our efforts to deliver purposeful work and meaningful impact every day. Learn more about what makes us different and how you can make your mark as a Clinical Consultant within our Employee Health & Benefits team here at MMA. Marsh McLennan Agency (MMA) provides business insurance, employee health & benefits, retirement, and private client insurance solutions to organizations and individuals seeking limitless possibilities. With offices across North America, we combine the personalized service model of a local consultant with the global resources of the world’s leading professional services firm, Marsh McLennan (NYSE: MRSH). A day in the life: The Clinical...

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....

Company: Marsh McLennan Agency Description: Health Management Consultant Reports to: Managing Consultant, Health Management Location: Worcester/Boston, MA Our not-so-secret sauce. Award-winning, inclusive, Top Workplace culture doesn’t happen overnight. It’s a result of hard work by extraordinary people. The industry’s brightest talent drive our efforts to deliver purposeful work and meaningful impact every day. Learn more about what makes us different and how you can make your mark as a Health Management Consultant within our Employee Health & Benefits team here at MMA. Marsh McLennan Agency (MMA) provides business insurance, employee health & benefits, retirement, and private client insurance solutions to organizations and individuals seeking limitless possibilities. With offices across North America, we combine the personalized service model of a local consultant with the global resources of the world’s leading professional services firm, Marsh...

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 Clinical Client Partner serves as a pharmacy subject-matter expert who supports the Client Success team by providing clinical insights, strategic recommendations, and formulary expertise for assigned client portfolios. While this role is not the primary relationship owner, it partners closely with Client Success Partners (CSPs), who lead the client relationship, to strengthen the clinical depth and value of client engagements....

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we  CARE  through our values,  Sustainability  initiatives and  inclusive corporate culture .   Our Medical Claims team is currently seeking a Sr. Medical Claims Consultant to join out growing team. This is a Full Time / Exempt role.     POSITION OVERVIEW: Provides claims adjusters and attorneys with detailed analysis of medical records and other pertinent medical information significant to allegations in liability claims. As a Senior Medical Claims Consultant, this professional assumes a leadership and SME role on the team, and has a skill level to evaluate a variety of medical issues in claims from various lines of business.   Responsibilities/Essential Functions: Reviews, analyzes, and summarizes medical records and other pertinent documents Researches current...

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we  CARE  through our values,  Sustainability  initiatives and  inclusive corporate culture .   Our Medical Claims team is currently seeking a Sr. Medical Claims Consultant to join out growing team. This is a Full Time / Exempt role.     POSITION OVERVIEW: Provides claims adjusters and attorneys with detailed analysis of medical records and other pertinent medical information significant to allegations in liability claims. As a Senior Medical Claims Consultant, this professional assumes a leadership and SME role on the team, and has a skill level to evaluate a variety of medical issues in claims from various lines of business.   Responsibilities/Essential Functions: Reviews, analyzes, and summarizes medical records and other pertinent documents Researches current...

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...

ABOUT HUB INTERNATIONAL: HUB International Limited (“HUB”) is one of the largest global insurance and employee benefits broker, providing a broad array of property, casualty, risk management, life and health, employee benefits, investment and wealth management products and services. With over 21,000 employees in 600+ offices throughout North America, HUB has grown substantially, in part due to our industry leading success in Mergers and Acquisitions. WHAT WE OFFER YOU: At HUB we believe in investing in the future of our employees.  Our entrepreneurial culture fosters an environment of open feedback and improvement that empowers our people to make the best decisions for our customers and organization.  We offer: Competitive salaries and benefits offerings Medical/dental/vision insurance and voluntary insurance options Health Savings Account funding 401k matching program Company paid Life and Short-Term Disability Plans Supplemental Life and Long-Term Disability...

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...

For over 20 years PSG (an EPIC owned company) 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 the plan’s advocate and strategic partner. 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. The Pharmacy Benefit Consultant - Health Plans will serve as primary and lead consultant on strategic clients’ projects with a focus on national and regional health plans. Lead and cultivate multi-level client relationships with senior executives, pharmacy department leadership and personnel, sales and product leads, clinical management and others which enable PSG to partner with clients to create, communicate and implement...

Job Description: Providing for loved ones, planning rewarding retirements, saving enough for whatever lies ahead – our policyholders count on us to be there when it matters most. It’s a big ask, but it’s one that we have the power to deliver when we work together. We collaborate and innovate – pushing one another to transform not just Pacific Life, but the entire industry for the better. Why? Because it’s the right thing to do. Pacific Life is more than a job, it’s a career with purpose. It’s a career where you have the support, balance, and resources to make a positive impact on the future – including your own. We’re actively seeking a talented Long Term Disability Claims Consultant (LTD) Benefits Consultant to play a key role in managing our customers’ LTD claims experience within the Workforce Benefits organization. This role is based in Chattanooga, TN or Omaha, NE . As an LTD Benefits Consultant, you will be a front‑line leader in managing complex LTD claims...

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...

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, you could have the flexibility of work-from-home time as defined by the leadership team. Auto-Owners Insurance, a top-rated insurance carrier, is seeking motivated nursing professional to join our team. The position requires the person to: Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the claimant’s health across the care continuum. Coordinate care delivery and support among claimant support systems, including providers, community-based agencies, and family. Collaborate with claims associates to provide medical expertise in the investigation, evaluation, and appropriate resolution of...

Company: Marsh McLennan Agency Description: Health Management Consultant Our not-so-secret sauce. Award-winning, inclusive, Top Workplace culture doesn’t happen overnight. It’s a result of hard work by extraordinary people. The industry’s brightest talent drive our efforts to deliver purposeful work and meaningful impact every day. Learn more about what makes us different and how you can make your mark as a Health Management Consultant at MMA. Marsh McLennan Agency (MMA) provides business insurance, employee health & benefits, retirement, and private client insurance solutions to organizations and individuals seeking limitless possibilities. With offices across North America, we combine the personalized service model of a local consultant with the global resources of the world’s leading professional services firm, Marsh McLennan (NYSE: MMC). The Planning & Analytics for Total Health (PATH) team at Marsh McLennan Agency combines real-time data insights...

Company: Marsh McLennan Agency Description: Strategic Client Executive, Rx Solutions Our not-so-secret sauce. Award-winning, inclusive, Top Workplace culture doesn’t happen overnight. It’s a result of hard work by extraordinary people. The industry’s brightest talent drive our efforts to deliver purposeful work and meaningful impact every day. Learn more about what makes us different and how you can make your mark as a Strategic Client Executive, Rx Solutions at MMA. Marsh McLennan Agency (MMA) provides business insurance, employee health & benefits, retirement, and private client insurance solutions to organizations and individuals seeking limitless possibilities. With offices across North America, we combine the personalized service model of a local consultant with the global resources of the world’s leading professional services firm, Marsh McLennan (NYSE: MMC). A day in the life. As our Strategic Client Executive on the Rx Solutions team,...

Company: Marsh McLennan Agency Description: Job Description For Posting Senior Client Manager Rx Solutions Our not-so-secret sauce. Award-winning, inclusive, Top Workplace culture doesn’t happen overnight. It’s a result of hard work by extraordinary people. The industry’s brightest talent drive our efforts to deliver purposeful work and meaningful impact every day. Learn more about what makes us different and how you can make your mark as a Senior Client Manager Rx Solutions at MMA. Marsh McLennan Agency (MMA) provides business insurance, employee health & benefits, retirement, and private client insurance solutions to organizations and individuals seeking limitless possibilities. With offices across North America, we combine the personalized service model of a local consultant with the global resources of the world’s leading professional services firm, Marsh McLennan (NYSE: MMC). MMA’s pharmacy specialists provide data-driven solutions and...