Executive Medical Director-Payment Integrity

Health Care Service Corp.; Richardson (TX); Hybrid; USD 215,000 - 399,000; Full time

Benefits offered by this job

Flex (Hybrid) schedule

Total rewards package

Job summary

Health Care Service Corporation is seeking a physician-lead to oversee medical policies and programs, performing reviews and engaging with provider communities. The role emphasizes strategic leadership, collaboration, and data-driven decision making to support managed care initiatives.

The candidate will apply clinical expertise to business strategies, lead teams, present recommendations, and manage budgets to optimize ROI while aligning with corporate goals.

Qualifications

• MD or DO with full, unrestricted medical license in the U.S.
• Board certification in a relevant medical specialty
• 5 years post-graduate clinical experience
• 5 years managed care experience applying medical problems to managed care
• Knowledge of medical/surgical techniques, reimbursement, and benefits management
• Leadership skills to guide groups toward consensus and strategic actions
• Strong verbal and written communication skills
• Experience achieving results through people
• Ability to meet deadlines under pressure and drive results
• Experience innovating and improving processes to align with business strategy
• Subject matter expert in a specified field
• Experience presenting and negotiating
• Strategic thinking skills
• Proficiency with computing and documentation tools (MS Office, Lotus Notes)
• Overseeing annual budget and allocating resources
• Translating needs into compelling business cases
• Conducting cost-benefit analyses to justify investments and ROI

Responsibilities

• Perform medical reviews and interact with provider communities for assigned areas
• Lead groups to consensus and convert strategy into action
• Translate clinical needs into actionable business cases
• Present findings and negotiate with stakeholders
• Oversee budget and allocate resources for projects

Skills

Leadership

Strategic thinking

Communication skills

Negotiation

Budget management

Process improvement

Medical policy

Office software

Education

MD or DO

Board certification

Tools

Microsoft Office

Lotus Notes

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for assigned aspects of medical policies and programs. Performs medical reviews and interacts with the provider communities for assigned areas.

JOB REQUIREMENTS

• Physician (M.D. or D.O) with a current and unrestricted physician license in a state or territory of the United States
• Maintain Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or the Advisory Board of Osteopathic Specialists
• 5 years of post-graduate patient care/clinical experience.
• 5 years of managed care experience coupled with proven experience in the application of medical problems to managed care practices.
• Knowledge of current medical and surgical techniques, reimbursement methodology, and benefit management.
• Leadership skills to lead groups to consensus and resolution building aligned to corporate strategy
• Demonstrated ability to independently make tough strategic decisions and move forward with actions on the strategies.
• Strong verbal and written communication skills.
• Experience achieving results through people.
• Experience being proactive and highly results oriented; able to meet deadlines under pressure.
• Experience thinking innovatively and developing process improvements to align with business strategies.
• Experience being the subject matter expert/leader in a specified field.
• Experience presenting and negotiating.
• Strategic thinking skills.
• Proficiency in computer use (including software applications such as Microsoft Office Product, Lotus Notes) needed for electronic documentation of case reviews
• Overseeing the annual budget and allocating resources for various projects and operational needs.
• Translating needs and initiatives into compelling business cases.
• Conducting cost-benefit analyses to justify investments and ensure ROI.

PREFERRED EXPERIENCE

• Experience developing business strategies, leading broad medical policy initiatives.
• Experience developing business strategies, leading broad medical policy initiatives.
• Legal/compliance experience
• Payment integrity/ Reimbursement experience
• This is a Flex (Hybrid) role: 3 days in office; 2 days remote.

Pay Transparency Statement

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. Flex employees are expected to be in the office a minimum of three days a week. Management will have discretion to modify an employee's weekly schedule for exigent circumstances.

HCSC Employment Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range $214,800.00 - $398,900.00 Exact compensation may vary based on skills, experience, and location.

For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved.