Medical Advisor

Responsibilities

  • Support the Medical Department with the review and follow-up of complex cases (before/during/after)
  • Process claims and manage long-term hospitalizations and air transfers
  • Evaluate medical cases and recommend courses of action for prior authorization following standard operating procedures
  • Make final decisions on claims classified as PDOC (pending medical review) within established response times
  • Provide medical expertise for pre-authorizations related to complex cases
  • Identify Simple vs. Complex cases to ensure compliance with standard operating procedures
  • Review and decide on claims classified as PRA-PDOC, P25K, and FYC within established timeframes

Requirements

  • Medical degree with valid license (executor)
  • Bilingual in English and Spanish (reading, writing, and verbal communication)
  • 5 years of experience in medicine or insurance
  • At least 2 years of medical practice
  • 3 years of experience in a customer service environment
  • 3 to 5 years of experience managing and resolving complex medical cases
  • Experience managing clinical records and knowledge of Major Medical Insurance
  • Availability to work rotating shifts (44 hours per week) between 3:00 p.m. and 9:00 a.m., including rotating holidays

About the Company

BGLA is an innovative team committed to employees and focused on customer care and assistance, offering a dynamic environment with development opportunities.

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