Physician Reviewer

Innovative Systems Group; Vaughan; Remote; CAD 100,000 - 130,000; Full time

Job summary

A leading company is seeking a Sr. Technical Recruiter to provide clinical expertise for Medicare Supplement and Supplemental Health Insurance products. The role requires a board-certified physician with extensive clinical experience and strong skills in teamwork, communication, and problem-solving. This position is full-time and offers the opportunity to lead a clinical team while collaborating across various departments.

Qualifications

• Board-certified physician with current unrestricted medical license and at least 10 years of clinical practice experience.
• Experience in Medigap, Supplemental Health Insurance, and Medical Underwriting preferred.

Responsibilities

• Provide clinical expertise and support for all departments related to Medicare Supplement and SHL Insurance products.
• Oversee the Supplemental Benefits Clinical Team (SBCT), including Medical Directors, pharmacists, and data analysts.
• Collaborate with the actuarial team for clinical integrity in underwriting, pricing, claims automation, and cost analysis.

Skills

Teamwork

Communication

Negotiation

Problem Solving

Decision-Making

Stakeholder Relations

Education

MBA

Tools

Data Science

Job description

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Innovative Systems Group, Sr. Technical Recruiter

Nashville, TN — (100% Remote from Nashville)

Shift (M-F 40 hours per week) — Candidate must be in Nashville Area.

Req: Board Certification/ABMS is required for the role.

Preferred qualifications: Internal Medicine, Geriatric, or Family practitioner with computer experience, presentation experience, case management experience, and appeal review experience.

Supplemental Benefits (CSB) provides peace-of-mind and financial security for more than 800,000 policyholders of all ages through Medicare Supplement and Supplemental Health and Life (SHL) products. Our environment is fast-paced, the work is meaningful and intense, and our performance expectations are high.

The CSB Medical Director will leverage extensive clinical experience to enable delivery of CSB’s market-leading strategies, improving the lives of the individuals we serve.

Key Job Functions:

1. Provide clinical expertise and support for all departments related to Medicare Supplement (Medigap) and SHL Insurance products, including Underwriting, Legal, Marketing, Operations, Product, and Claims.
2. Ensure strategic and tactical delivery of project work for these products across forty-nine states and DC.
3. Support Medigap underwriters, assist claims representatives with complex claims, appeals, reviews, rescissions, fraud, and abuse cases.
4. Oversee the Supplemental Benefits Clinical Team (SBCT), including Medical Directors, pharmacists, data analysts, and other members.
5. Collaborate with the actuarial team for clinical integrity in underwriting, pricing, claims automation, and cost analysis.
6. Contribute to developing new tactics and methodologies to improve cost containment, such as Preventive Care and vendor solutions.

Minimum Qualifications:

• Board-certified physician with current unrestricted medical license and at least 10 years of clinical practice experience. Ability to obtain licenses as needed.
• Experience in Medigap, Supplemental Health Insurance, and Medical Underwriting preferred.
• MBA or equivalent experience preferred.
• Proven ability to assess complex issues, recommend changes, and resolve issues.
• Strong skills in teamwork, communication, negotiation, conflict management, problem solving, decision-making, and stakeholder relations.
• Ability to educate clinical and non-clinical staff effectively.
• Strong computer skills; data science background is a plus.
• Strategic thinking, analytical, and decision-making skills.
• Experience in developing and delivering professional presentations, including to senior management.
• Ability to work independently and under pressure.
• Strong interpersonal and collaboration skills to develop effective relationships.

Seniority level

• Director

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Health and Human Services