Médico Asesor Nocturno

This is a fully remote position, open to applicants in Dominican Republic.

📋 Description

• Provide support to the Medical Department by reviewing and monitoring complex cases (before/during/after)

• Claims processing

• Management of long-term admissions and air transfers

• Assist the Medical Advisor in evaluating medical cases and recommending the appropriate course of action following standard operating procedures for prior authorization

• Review and make final decisions on claims classified as PDOC (pending medical review) within the established response time

• Deliver excellent internal and external customer service to strengthen our brand in the market

• Provide advice and/or make final decisions on when medical expertise is needed to complete the processing of a prior authorization related to complex cases

• Review and finalize decisions on claims classified as PRA-PDOC (first-year claims) within the established response time

• Ensure the correct identification of Simple vs. Complex cases to comply with the established Standard Operating Procedures for Pre-authorization and Case Management

• Review and make final decisions on claims classified as P25K (claims over 25K) within the established response time

• Review and finalize decisions on claims classified as FYC (first-year claims) within the established response time

⛳️ Requirements

• Medical degree and possession of a medical license

• Bilingual in English/Spanish with the ability to read and write correspondence and respond verbally to inquiries

• Five (5) years of experience in the field of medicine or insurance, with at least two (2) years of medical practice required

• Three (3) years of experience in a customer service environment

• Three to five (3-5) years of experience in managing and resolving complex medical cases

• Experience in managing clinical records

• Knowledge of Major Medical Expense Insurance

• Availability to work rotating shifts: 44 hours a week within a schedule range from 3:00 p.m. to 9:00 a.m. and rotating holidays

🏝️ Benefits

• Remote work model

• Competitive fixed salary

• Indefinite contract