Medical Officer

Southern Cross Medical Care Society; Auckland; On-site; NZD 120,000 - 150,000; Full time

Job summary

Southern Cross Health Insurance in Auckland is seeking a Medical Officer to blend clinical excellence with evidence-based decision making. You will translate medical evidence into practical guidance for funding treatments, eligibility, and provider partnerships, while shaping value-based care initiatives and AI-enabled analytics.

You’ll work across claims, underwriting, member advocacy, and data teams, ensuring decisions are fair, transparent, and grounded in robust clinical reasoning.

Qualifications

• A Bachelor of Medicine and Bachelor of Surgery (MBChB) or an equivalent recognised medical qualification.
• More than two years’ clinical medicine experience, including healthcare research, evidence review or analysis.
• Strong research capability – assess clinical evidence, best‑practice guidance and emerging health technologies.
• Confident, hands‑on use of data and approved AI tools, including working with large datasets and checking outputs back against source evidence.
• Experience with data analysis or visualisation tools, or the ability to pick them up quickly.
• A working understanding of structured clinical data, including ICD-10, procedure coding and claims data.
• Strong analytical and critical thinking, sound judgement and a good eye for detail.
• Advanced written and verbal communication skills – you can explain clinical concepts in plain language to people who aren’t clinicians.
• Strong stakeholder skills across operational teams, clinical leaders, providers and external representatives.
• Professional judgement, confidentiality and integrity when working with sensitive member, provider and business information.
• A curious, collaborative working style – you’re comfortable sharing knowledge, asking questions and working alongside teams who are still learning what good AI use looks like.

Responsibilities

• Give clear medical advice to internal teams on treatment funding, eligibility criteria, claims, underwriting and member-related matters – including Member Advocacy cases involving ACC coverage declines.
• Apply clinical judgement and evidence to decisions on new and emerging health technologies.
• Review value‑based healthcare initiatives and support their governance, outcome measures and reporting quality.
• Use data, analytics and approved AI tools to analyse claims, clinical evidence, coding and provider patterns – and turn what you find into practical advice and negotiation insight.
• Check AI outputs against source evidence and keep human accountability at the centre of clinical decisions.
• Spot opportunities to digitise or automate manual clinical work – evidence summaries, eligibility checks, claims review – and help build and test improved workflows that simplify the work while protecting member privacy.
• Support provider and industry conversations that improve quality, transparency and outcome‑based treatment pathways for members.
• Identify clinical risks and opportunities early, and propose practical options so teams can make fair, consistent and defensible decisions.
• Explain complex clinical information in plain language so stakeholders can act with confidence.

Skills

MBChB or equivalent

2+ years clinical medicine experience

Data analysis

AI tools familiarity

Strong written and verbal comms

Stakeholder management

Education

MBChB or equivalent

Tools

Data analysis tools

AI tools

ICD-10 coding knowledge

Job description

About us

Southern Cross Health Insurance is shaping a healthier Aotearoa New Zealand. Our purpose is simple: empowering our members to live well for longer. We're here to give peace of mind through timely access to quality care, inspire healthier living, and lead positive change across the health system. As a New Zealand‑owned, member‑based organisation, we're building a future where wellbeing is at the heart of everything we do -- delivering exceptional value for our members and creating an environment where our people thrive. Now is an exciting time to join us. You'll be part of a high-performing, values-driven team where people are at the heart of everything we do -- and in return for your talent, you'll have the opportunity to grow, make an impact, and be proud of the difference your work makes.

About the role

If you’re a doctor who enjoys the evidence and analysis side of medicine as much as the clinical side – and you’re curious about how clinical judgement shapes decisions at a health insurer – this role could be a great fit. Every day, Southern Cross makes decisions that shape the care our members can access: which treatments we fund, who’s eligible, and how we respond to new and emerging health technologies. Those decisions need to be fair, evidence‑based and clearly explained, and our Medical Officer is the person who makes sure the clinical thinking behind them stacks up. As our Medical Officer, you’ll be the clinical voice for teams across the business – claims, underwriting, member advocacy, healthcare partnerships and data – turning complex medical evidence into practical advice people can act on. You’ll also support our value‑based healthcare initiatives and the provider conversations that help improve treatment pathways for members. We’re also building out how we use data and approved AI tools in clinical work – analysing claims and provider patterns, summarising evidence, streamlining eligibility checks – so you’ll have the opportunity to help shape what good looks like, while keeping a person accountable for every clinical decision. This is a 12‑month fixed‑term role based in Auckland, covering an internal secondment.

What you’ll do

• Give clear medical advice to internal teams on treatment funding, eligibility criteria, claims, underwriting and member-related matters – including Member Advocacy cases involving ACC coverage declines.
• Apply clinical judgement and evidence to decisions on new and emerging health technologies.
• Review value‑based healthcare initiatives and support their governance, outcome measures and reporting quality.
• Use data, analytics and approved AI tools to analyse claims, clinical evidence, coding and provider patterns – and turn what you find into practical advice and negotiation insight.
• Check AI outputs against source evidence and keep human accountability at the centre of clinical decisions.
• Spot opportunities to digitise or automate manual clinical work – evidence summaries, eligibility checks, claims review – and help build and test improved workflows that simplify the work while protecting member privacy.
• Support provider and industry conversations that improve quality, transparency and outcome‑based treatment pathways for members.
• Identify clinical risks and opportunities early, and propose practical options so teams can make fair, consistent and defensible decisions.
• Explain complex clinical information in plain language so stakeholders can act with confidence.

What you’ll bring

• A Bachelor of Medicine and Bachelor of Surgery (MBChB) or an equivalent recognised medical qualification.
• More than two years’ clinical medicine experience, including healthcare research, evidence review or analysis.
• Strong research capability – you can assess clinical evidence, best‑practice guidance and emerging health technologies, and form a clear view on what the evidence does and doesn’t support.
• Confident, hands‑on use of data and approved AI tools, including working with large datasets and checking outputs back against source evidence.
• Experience with data analysis or visualisation tools, or the ability to pick them up quickly.
• A working understanding of structured clinical data, including ICD-10, procedure coding and claims data.
• Strong analytical and critical thinking, sound judgement and a good eye for detail.
• Advanced written and verbal communication skills – you can explain clinical concepts in plain language to people who aren’t clinicians.
• Strong stakeholder skills across operational teams, clinical leaders, providers and external representatives.
• Professional judgement, confidentiality and integrity when working with sensitive member, provider and business information.
• A curious, collaborative working style – you’re comfortable sharing knowledge, asking questions and working alongside teams who are still learning what good AI use looks like.

Who we are

Ngākau nui. Āhurutanga. Tikanga. Join a proud diverse team, that’s always there, always real, always true. If you thrive in a caring, honest and open culture, we think you’ll love working with us. We know that it is our team’s culture and wellbeing that will drive us forward. That’s why we prioritise not only professional development opportunities but opportunities to thrive personally, too. We offer exceptional work/life balance and our employees are encouraged to — and rewarded for — living well.

What we offer you

Based at our Auckland office Te Kupenga, you’ll be supported to continually learn and grow your skills, share knowledge and ideas, and be part of a values-based culture where people are at its heart. This is a 12‑month fixed‑term role covering a secondment, based in Auckland. While we appreciate interest from candidates in other locations, we’ll manage remote working options on a case‑by‑case basis for the right candidate. Have questions? Check out our FAQs for help with the application and recruitment process. We are proud to have taken the Pride Pledge, reflecting our commitment to inclusion and belonging. We also facilitat e an active, employee‑led Diversity, Equity and Inclusion Forum, which includes our Rainbow Network, Māori Network, Pasifika Collective, and Neurodiversity and Whānau Support networks. If you share our commitment and passion, we'd love to hear from you.

About us

Southern Cross Health Insurance is shaping a healthier Aotearoa New Zealand. Our purpose is simple: empowering our members to live well for longer. We’re here to give peace of mind through timely access to quality care, inspire healthier living, and lead positive change across the health system. As a New Zealand‑owned, member‑based organisation, we’re building a future where wellbeing is at the heart of everything we do — delivering exceptional value for our members and creating an environment where our people thrive. Now is an exciting time to join us. You’ll be part of a high‑performing, values‑driven team where people are at the heart of everything we do — and in return for your talent, you’ll have the opportunity to grow, make an impact, and be proud of the difference your work makes.