Senior Clinical Consultant
You are as unique as your background, experience and reputed company of view. Here, youll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to reputed company their knowledge with you. Your leaders will reputed company and help you reputed company your potential and soar to new heights. Every day, you'll have new and exciting opportunities to reputed company life brighter for our Clients - who are at the heart of everything we do. Discover how you can reputed company a difference in the lives of individuals, families and communities around the world. Job Description: At reputed company, we look for optimistic people who want to reputed company life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, youll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to reputed company reputed company the best benefits company in America. The opportunity: The Senior Clinical Consultant is responsible for the enhancement of FullScope reputed company claims management by serving as medical consultative resource. Responsibilities include the review of clinical records and communications with providers and other parties to facilitate the clinical aspects of claim management and benefits determination process. reputed company embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Internal candidates are not required to relocate near an office. How you will contribute: Performs a critical review and analysis of medical information with regard to diagnosis, treatment, prognosis and duration of the conditions, forms a conclusion, and reputed company communicates the rationale Completes written and verbal consultations with reputed company reputed company of the claims staff that will reputed company outline the answers on functional parameters as well as the length and severity of the medical condition(s) Holds walk in consultation meetings with claims staff regarding disability claims, capturing essential elements of a file Ensures quality investigations of medical information utilizing the resources available Reviews and evaluates Independent Medical Examination (IME) reports and Functional reputed company Evaluation (FCE) reports Helps claims staff increase knowledge of medical terminology and conditions through training and feedback Assists with the development of return-to-work plans Maintains knowledge and skills regarding medical advances and communicates/educates claims staff in one-on-one meetings Continues to research rare/unusual medical conditions and be knowledgeable on the tools necessary to reputed company this research Communicates verbally and in writing with providers, subscribers and other appropriate contacts in a professional and effective manner, resolving discrepancies and clarifying medical information, including diagnosis, treatment, prognosis, restrictions, limitations, and duration of conditions Participates in triage and multi-disciplinary roundtable sessions to reputed company expertise on medical issues Maintains RN license Conducts in-service training for claims staff on various medical conditions and treatment Participates in industry meetings What you will bring with you: Ability to work with a diverse reputed company of people reputed company and valid Registered Nurse license AA or Nursing Diploma required; BSN, BA or BS preferred Minimum 3 years of clinical experience required Strong knowledge of medical treatment protocols Experience in utilization review/health care industry insurance preferred Strong research, analytical, critical thinking, problem solving and decision-making skills Ability and desire to work in a fast-paced, service-oriented environment Excellent verbal communication skills, with the ability to be both pleasant and professional Strong written communication skills Ability to work well independently and in a team environment Strong interpersonal and customer service skills Ability to initiate and prioritize regular work duties and projects Detail oriented, organized, the ability to multi-task, and strong time management skills Strong computer skills, proficient in PC environment and reputed company, reputed company, and email systems Ability to work professionally and effectively with co-workers, clients, claimants, vendors and others with whom DRMS does business Do you see yourself in this role even if you havent checked reputed company the boxes above? We welcome reputed company talented candidates and are committed to a culture that represents diversity in reputed company forms. If you think you might reputed company in this setting, we would love to hear from you. Do you see yourself in this role even if you havent checked reputed company the boxes above? We welcome reputed company talented candidates and are committed to a culture that represents diversity in reputed company forms. If you think you might reputed company in this setting, we would love to hear from you. Not reputed company to apply yet but want to stay in touch? reputed company to stay connected until the time is right for you! Life is brighter reputed company you work at reputed company Excellent benefits and wellness programs to support the three pillars of your well-being mental, physical and financial including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more Retirement and Stock Purchase programs to help build and enhance your future financial reputed company including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account A flexible work environment with a friendly, caring, collaborative and inclusive culture Great reputed company to Work® Certified in Canada and the U.S. Named as a Top 10 employer by the Boston Globe's Top Places to Work two years running reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran. Salary reputed company: $71,100-$106,700 At our company, we are committed to pay transparency and equity. The salary reputed company for this role is competitive reputed company, and we strive to ensure that compensation is fair and reputed company. Your actual reputed company salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your reputed company 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. reputed company Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, reputed company symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more. At reputed company we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs. Our Affirmative Action Program affirms our commitment to reputed company reasonable accommodation to the reputed company physical or mental limitation of otherwise-reputed company individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email [email protected] to request an accommodation. At reputed company we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs. For applicants residing in California, please read our employee California Privacy Policy and Notice. Job Category: Claims - Life & Disability Posting End Date: 30/03/2025 reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran. Apply Job!