A+H Medical Director in Milwaukee, WI at National General Insurance

Date Posted: 6/4/2021

Job Snapshot

Job Description

Primary Purpose:

Serve as a highly skilled medical professional responsible for clinical support and assisting in the establishment of policies and procedures in regards to plan development and underwriting policy.  Work assignments will involve moderately to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. 

Essential Duties and Responsibilities:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

•Provide consultation on cases involving complex medical conditions

•Review and recommend underwriting action on cases considered to be high risk

•Review underwriting and claims appeals from distribution and producers

•Review DOI complaints and provide guidance to the Correspondence team

•Review and interpret medical tests

•Provide underwriter training, development and skills assessment

•Develop and maintain training material

•Participate in medical underwriting quality and skills assessments

•Make presentations to leadership regarding advances in medical research, treatment, and therapies

•Participate in insurance, underwriting and professional trade group organizations and meetings

•Advisor on grievance and rescission panels

Minimum Skills and Competencies:

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

•MD degree with medical training obtained from an accredited medical institution

•10+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment

•Board Certified in an approved ABMS Medical Specialty with continued certification throughout employment

•A current and unrestricted license and willing to obtain additional license(s), if required

•No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements

•Excellent verbal and written communication skills

•Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on Claims, Appeals, Case Management, Underwriting, and Legal

•Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)

•Must possess effective verbal and written communication skills

•Must perform well in high-energy, dynamic and team-oriented environments

•Effective organization and time management skills with the ability to work under pressure and adhere to project deadlines

Desired Skills:

•Knowledge of the managed care industry including Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management

•Utilization management experience in a medical management review organization, Commercial health insurance

•Certified Coding Specialist – Physician-based (CCS-P)

•Experience with national guidelines such as MCG®

•Internal Medicine or Family Practice specialization

•Advanced degree such as an MBA or MHA

•Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health

•The curiosity to learn, the flexibility to adapt and the courage to innovate

#LI-AS1

National General Holdings Corp. is an Equal Opportunity (EO) employer – Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas.

In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at (336) 435-2000.

Job Requirements

About National General Holdings:

National General Holdings Corp., a member of the Allstate family of companies, is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A– (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.

National General is a fast paced, dynamic, and entrepreneurial organization. Our team members live by and exemplify what we call the 4Es. At National General, we are Energized, Engaged, Empowered, and we Execute every day in order to provide an exceptional experience for our customers! We are passionate about our organization and the value that we add every day. A successful candidate with National General will embody the 4Es. Our team is poised to outperform the competition. We are National General Insurance and with us you can be extraordinary! Come join our team!

Companies and Partners

Direct General Auto & Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident.

In addition to a phenomenal career opportunity, National General Insurance offers an excellent benefits package including:

• Paid Training
• Medical, Dental, Vision benefits
• Wellness Programs
• Life and Short/Long Term Disability Insurance
• 401k w/ Company Match
• Company Paid Holidays & Generous Time-off policy
• Employee Discount Program
• Career Advancement and Development Opportunities
• On-site Healthcare Clinic (Winston-Salem and Cleveland offices)
• On-site Fitness Center (Cleveland and Dallas offices)
• Subsidized parking (Cleveland office)

National General Holdings Corp. is an Equal Opportunity (EO) employer – Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas.

In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at (336) 435-2000.

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