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Employee Benefits Clinical Consultant
HUB International. Review and interpret medical and pharmacy claims data .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in reviewing and interpreting medical and pharmacy claims data while applying clinical knowledge of disease states and treatment protocols. Proficient in compliance with HIPAA and confidentiality standards, with strong communication and organizational skills.
Highest-signal resume keywords
Clinical Knowledge of Disease StatesMedical Claims Data InterpretationHIPAA ComplianceMicrosoft Office ProficiencyDirect Patient Care Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Claims Data ReviewPharmacy Claims Data InterpretationClinical Risk Factor AnalysisUtilization Pattern IdentificationCondition InterpretationRisk EducationEmerging Treatment ResearchClinical Deliverable PreparationPatient Care ExperienceTreatment Protocol Knowledge
Soft Skills
Strong Written CommunicationStrong Verbal CommunicationOrganizational SkillsTime-Management SkillsAbility to Prioritize Workload
Tools & Technologies
Microsoft ExcelMicrosoft PowerPointMicrosoft Word
Certifications & Qualifications
Bachelor's Degree in Health-Related FieldActive RN LicenseLPN/LVN License
Industry Keywords
HIPAAPHIRegulatory ComplianceConfidentiality StandardsClinical Practice
About the role
Key responsibilities & impact- Review and interpret medical and pharmacy claims data
- Apply clinical knowledge of disease states, treatment protocols, and pharmacology to identify utilization patterns, cost drivers, and gaps in care
- Learn and adapt to new reporting and technology tools
- Provide condition interpretation and risk education grounded in standards of care and medical necessity
- Review clinical risk factors and treatment patterns among large or complex claimants
- Identify emergency room, hospital admission, specialty drug, and site-of-care utilization patterns
- Share clinical interpretation with account teams and specialty partners
- Support account team preparation for carrier conversations and participate in discussions as directed
- Prepare clinical deliverables and present on client calls as assigned
- Research emerging treatment, drug, and site-of-care trends
- Maintain compliance with regulatory, HIPAA, PHI, company, and confidentiality standards
- Perform other duties as assigned
Requirements
What you’ll need- Bachelor's degree in a health-related field required; BSN active RN license preferred
- Associate-level Registered Nurse (RN) or Licensed Practical/Vocational Nurse (LPN/LVN) with an active license and relevant clinical experience may be considered in lieu of a bachelor's degree
- Two (2) to five (5) years of direct patient care or clinical practice experience required
- Proficient in Microsoft Office products, including Excel, PowerPoint, and Word
- Strong written and verbal communication skills
- Strong organizational and time-management skills
- Ability to prioritize a varied workload and manage day-to-day responsibilities with minimal oversight
- Knowledge of HIPAA, PHI protections, state and federal regulations, company policies, and client confidentiality standards