Job Description: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK.
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 Medical Stop Loss insurance experience or 3+ years of complex clinical case management experience in medical, workers' compensation, or another health insurance setting
- 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: $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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Job Category: Claims - Clinical
Posting End Date: 25/10/2026
