Senior Clinical Risk & Claims Optimization Advisor

Sun Life; Kansas City (MO); Hybrid; USD 79,000 - 118,000; Full time

Benefits offered by this job

Generous vacation & sick time

Paid family, parental & adoption leave

Medical coverage

401(k) employee match

Job summary

Sun Life U.S. is seeking a Senior Clinical Risk Consultant to leverage medical knowledge to review claims, underwriting prospects and renewals, and determine cost-effective care options.

This non-patient-facing role requires understanding of medical insurance and collaboration with claims, underwriting, and sales teams. The position is hybrid, based in the contiguous states plus AK, with a focus on cost savings, treatment plan reviews (transplants, CAR‑T, and emerging gene therapies), and

Qualifications

• Active Registered Nurse license.
• 5+ years of clinical nursing experience.
• Experience with medical stop loss or complex case management in health insurance.

Responsibilities

• Coordinate with claims, underwriting, and sales to review medical claims for appropriateness and cost.
• Investigate charges, negotiate costs, and identify billing errors for potential savings.
• Review complex treatment plans (transplants, CAR‑T, gene therapies) for coverage.
• Create and deliver educational presentations for internal and external audiences.

Skills

RN license

Clinical nursing

Stop-Loss experience

Case management

Cost review

Job description

Sun Life U.S. is seeking a Senior Clinical Risk Consultant to leverage medical knowledge to review claims, underwriting prospects and renewals, and determine cost-effective care options.

This non-patient-facing role requires understanding of medical insurance and collaboration with claims, underwriting, and sales teams. The position is hybrid, based in the contiguous states plus AK, with a focus on cost savings, treatment plan reviews (transplants, CAR‑T, and emerging gene therapies), and