Board Certified Orthopedic Surgeon Workers Compensation File Review, Independent Contractor

The Carolinas Center for Medical Excellence • Raleigh, NC

187d

About The Position

Constellation Quality Health seeks a Board-Certified Orthopedic Surgeon (M.D.) with at least three years of experience reviewing workers' compensation claim files to support our healthcare fraud, waste, and abuse (FWA) detection efforts. In this independent consultant role, you will review medical documentation to assess the appropriateness of care, validate billing practices, and identify patterns of overutilization, upcoding, or non-medically necessary services.

Requirements

• Medical Doctor (M.D.) with Board Certification in Orthopedic Surgery.
• Active and unrestricted medical license in the United States.
• Minimum of 3 years experience reviewing workers compensation claims or performing peer reviews/IMEs with a focus on fraud, waste, and abuse.
• Strong understanding of evidence-based orthopedic care, clinical guidelines, and utilization review standards.
• Excellent written and verbal communication skills.
• Experience with providing expert witness or deposition testimony.

Responsibilities

• Conduct detailed reviews of workers compensation medical records, operative reports, and billing files.
• Assess consistency between diagnosis, procedures, and clinical documentation.
• Identify potential FWA indicators related to orthopedic care (e.g., excessive imaging, unnecessary surgeries, prolonged disability timelines).
• Provide written summaries and expert opinions based on medical evidence and accepted clinical standards.
• Collaborate with clinical and investigative teams to support case development and legal proceedings as needed.

Benefits

• Competitive salary
• Flexible work environment

What This Job Offers

• Career Level: Senior
• Industry: Ambulatory Health Care Services
• Education Level: No Education Listed
• Number of Employees: 101-250 employees