Cost Containment Consultant

The Cost Containment Consultant will serve as a subject matter expert for company cost containment programs, including TPAs, Large Case Managers, Sales, Underwriters, Client Representatives, and Brokers, and will act as a consultant to underwriting. This role involves evaluating medical information to clarify diagnoses, assess medical condition severity, and estimate recovery duration, as well as assisting TPAs with cost containment options for high-cost claims such as transplants, specialty medications, dialysis, hemophilia, neonatal, and cancers. The consultant will also analyze transplant contracts, provide guidance on selecting the best contract for clients, research clinical conditions, and conduct analytical reviews of medical and/or pharmacy data. Additionally, the role includes managing vendors, participating in vetting new vendors, establishing standard work, performing root cause problem solving for the cost containment team, and developing relationships with key external and internal stakeholders to facilitate optimal cost savings. Travel and other duties as assigned are also part of the responsibilities.