Medical Director

🕒 June 4

🇺🇸 United States – Remote

💵 $167.5k - $229.8k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Allstate

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1931

💸 Finance

💰 Post-IPO Equity on 2014-01

Insurance • Finance

Allstate is an industry leader in providing insurance solutions, focusing on home, auto, device, and identity protection. With a commitment to customer well-being, Allstate aims to instill peace of mind and financial security for its customers. The company also emphasizes community impact and sustainability through various initiatives, showcasing their dedication to social responsibility and positive change.

📋 Description

• Provides clinical oversight and governance for the medical review program, including appeals, rescission, and grievance panel processes • Conducts comprehensive clinical reviews for first and second-level appeals, including Department of Insurance (DOI) complaints • Evaluates complex medical cases to ensure consistency with policy provisions, clinical guidelines, and regulatory requirements • Provides expert clinical judgment in high-risk or sensitive determinations • Provides independent clinical judgement in support of coverage determinations, free from claims or financial influence • Supports alignment and consistency across appeal outcomes and internal review processes • Leads clinical evaluation and decision-making for rescission cases and member grievances • Ensures appropriate application of underwriting intent and policy interpretation in misrepresentation reviews • Partners with legal on complex or escalated cases • Partners with legal to ensure compliance with applicable state and federal requirements governing adverse benefit determinations, grievance processes, and clinical review standards • Documents clinical rationale supporting determinations in a manner suitable for regulatory review, audits and litigation • Identifies opportunities to improve upstream underwriting and risk selection practices • Supports quality assurance and consistency of TPA decision-making • Partners with product management and actuarial teams to inform product design and risk selection strategies • Identifies trends and provides clinical insight on emerging risks, market trends, and competitive positioning • Contributes to and helps advance initiatives to integrate AI and/or automation into medical review workflows • Proactively identifies and raises opportunities to streamline processes and improve efficiency • Partners with stakeholders to help maintain alignment on priorities, timelines, and expected outcomes

🎯 Requirements

• 4 year Bachelors Degree (Required) • MD or DO (Required) • 8 or more years of experience (Required) • Active and unrestricted license to practice medicine (Required) • Experience working with health insurance preferred • MS Word, PowerPoint and Excel spreadsheet skills • Effective communication skills, verbal and written • Ability to handle shifting priorities • Effective presentation skills including the ability to present complex medical risk information.

🏖️ Benefits

• Allstate provides a comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse. • Employees eligible to work from home also receive a monthly connectivity reimbursement to help offset internet costs. • Reliable internet is required, with minimum speeds of 50 MB download and 5 MB upload.