Medical Director (Appeals)

HCSC Group; Chicago, Northern (IL, KY); Hybrid; USD 192,000 - 356,000; Full time

Job summary

Health Care Service Corporation (HCSC) seeks a physician to manage assigned aspects of medical policies and programs. The role entails performing medical reviews and engaging with provider communities for designated areas.

Requirements include an MD/DO with an active license, board certification, at least five years of clinical experience, strong analytical and communication skills, strategic thinking, and proficiency with MS Office and Lotus Notes.

Qualifications

• MD or DO with an active license in the United States
• Board Certification by ABMS/NBME or Advisory Board
• 5 years of clinical experience
• Analytical and communication skills
• Strategic thinking skills
• Proficiency in computer skills (MS Office, Lotus Notes)

Responsibilities

• Responsible for assigned aspects of medical policies and programs
• Performs medical reviews
• Interacts with provider communities for assigned areas

Skills

Analytical skills

Communication skills

Strategic thinking

Tools

Microsoft Office

Lotus Notes

Job description

Job Summary

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. 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 clinical experience
• Analytical and communication skills
• Strategic thinking skills
• Proficiency in computer skills (including software applications such as Microsoft Office Product and Lotus Notes) needed for electronic documentation of case reviews

Preferred Requirements

• 3 years Managed Care experience
• Cardiology, Gastroenterology, Rheumatology, Dermatology, Hematology, Oncology adn internal medicince specialties preferred but nt required

This is a remote work from home role (#LI-MG1).

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.

• 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

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.

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 an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.

Base Pay Range $191,500.00 - $355,600.00 Exact compensation may vary based on skills, experience, and location.

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.

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.