In this role, you’ll shape medical policy, oversee complex case reviews, and guide strategic decisions that support sound risk management and high-quality claim and underwriting outcomes. This position blends hands-on clinical expertise with executive leadership and cross-functional collaboration.
WHAT WE CAN OFFER YOU:
- Estimated Salary: $201,000 - $276,500, plus annual bonus opportunity.
- 401(k) plan with a 2% company contribution and 6% company match.
- Work-life balance with vacation, personal time and paid holidays. See our benefits and perks page for details.
- Applicants for this position must not now, nor at any point in the future, require sponsorship for employment.
WHAT YOU'LL DO:
- Lead and oversee medical review operations supporting underwriting and claims, ensuring efficient workflows and high-quality outcomes.
- Develop and maintain medical policies, protocols, and guidelines to support accurate and defensible decision-making.
- Review complex medical cases, including high-risk, denied, and appealed claims, and provide final-level medical consultation when needed.
- Provide strategic direction for medical review activities, including utilization review, fraud detection, and risk management initiatives.
- Partner with business leaders to support new product development, underwriting philosophy, and claims strategies.
- Manage departmental operations, including budgeting, staffing, training, and short- and long-term planning.
- Represent the organization in internal leadership forums and external medical director meetings, collaborating with peers and industry experts.
WHAT YOU’LL BRING:
- Medical degree (MD or DO) with an unrestricted license to practice medicine.
- Clinical background in internal medicine, family medicine, or primary care.
- Experience reviewing medical cases within insurance underwriting and/or claims environments.
- Demonstrated leadership experience managing medical teams or programs.
- Strong analytical and decision-making skills with the ability to interpret complex medical information.
- Excellent communication and relationship-building skills with both clinical and business stakeholders.
- Strong organizational and planning skills with the ability to manage multiple priorities.
- You promote a culture of diversity and inclusion, value different ideas and opinions, and listen courageously, remaining curious in all that you do.
- Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico.
PREFERRED:
- Prior experience supporting underwriting functions within insurance operations.
- Experience developing medical policy or contributing to product development initiatives.
We value diverse experience, skills, and passion for innovation. If your experience aligns with the listed requirements, please apply!
If you have questions about your application or the hiring process, email our Talent Acquisition area at [email protected]. Please allow at least one week from time of applying if you are checking on the status.
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