Licensed Medical Director

Job Summary

Providing strategic oversight and day-to-day management of the medical review process for disability claims, the full-time Licensed Medical Director will collaborate with claims and clinical professionals to evaluate complex medical cases remotely.

Key responsibilities

• Plan, lead, and control activities in medical review, underwriting, and claims, including project planning and budget management
• Provide professional oversight for medical review, ensuring compliance with medical standards and conducting utilization analysis
• Formulate policies and procedures for medical reviews of claims, focusing on increasing effectiveness and addressing fraud, waste, and abuse

Required qualifications

• Medical degree with an unrestricted license and appropriate board certification
• Hands-on experience in claims review, with a strong understanding of insurance processes
• Background in Internal Medicine, Family Medicine, or Primary Care settings
• Demonstrated organizational, planning, analytical, and management skills
• Ability to work remotely with access to a high-speed internet connection, located in the United States or Puerto Rico