Employee Benefits Clinical Consultant
Core
A clinical consultant providing specialized medical and pharmacy claims analysis to identify utilization patterns, cost drivers, and care gaps for employee benefit plans.
Role type
Clinical Consultant (Employee Benefits)
Builds
Actionable clinical insights and risk assessments supporting client strategy and plan design.
Domain
Employee Benefits / Health Economics and Outcomes Research (HEOR)
Required skills
Clinical knowledge of disease states and treatment protocols, Claims data analysis, Risk education, Regulatory compliance (HIPAA), Microsoft Office proficiency
Preferred skills
Active RN license, Bachelor's degree in health-related field
Technologies
Microsoft Office (Excel, PowerPoint, Word)
Responsibilities
Review and interpret medical/pharmacy claims data to identify utilization patterns and cost drivers; Provide condition interpretation and risk education to account teams; Analyze clinical risk factors for large/complex claimants; Distinguish clinically necessary care from avoidable utilization; Support carrier conversations with clinical data; Maintain compliance with HIPAA and regulatory standards.
Seniority
Mid-level (2-5 years experience)