Medical Consultant
About The Position
As a Medical Consultant, you will serve as one of the organization's medical subject matter experts, providing consultative support on highly complex underwriting cases. You will partner with underwriters and medical staff to evaluate sophisticated medical risks and deliver timely, evidence-based guidance that supports sound business decisions and exceptional customer outcomes. This role offers the opportunity to influence underwriting practices across the enterprise through education, training, and leadership of key medical initiatives. You will play a critical role in advancing medical risk assessment practices, enhancing consistency in decision-making, and ensuring medical guidelines reflect current clinical knowledge and emerging trends in insurance medicine.
Requirements
- Bachelor of Science in Nursing
- Active licenses in one of the following: RN, NP, APRN, PA
- 7+ years of clinical healthcare experience in a medical, nursing, or advanced practice setting
- 7+ years of experience reviewing and interpreting medical records, physician documentation, laboratory reports, and diagnostic testing
- 1+ year experience interpreting EKG/ECG findings within a clinical or insurance medical setting
Nice To Haves
- 10+ years of experience in insurance medicine, life underwriting, disability claims, or related medical risk assessment functions
- 3+ years experience supporting life insurance underwriting, disability insurance claims, insurance medicine, occupational medicine, utilization review, case management, or a comparable medical risk assessment function
- Advanced clinical credential such as APRN, NP, CNS, PA-C, MD, or DO
- Certification in Insurance Medicine (e.g., ALU, FALU, FLMI, CLU, or equivalent insurance-related designation)
- Experience developing underwriting guidelines, medical manuals, or clinical decision-support tools
- Experience designing and delivering training programs for underwriting, claims, or medical professionals
- Bilingual proficiency in Spanish and/or Mandarin
- Demonstrated expertise in mortality and morbidity risk assessment within life insurance, disability insurance, or related financial services environments
- Experience leading cross-functional initiatives and influencing business partners on medical risk strategy
- Strong written and verbal communication skills
Responsibilities
- Evaluate the most complex and medically challenging individual life insurance underwriting and disability claims referrals, providing expert consultation that supports accurate and timely risk assessment decisions.
- Review, interpret, and evaluate attending physician statements (APS), medical records, laboratory results, laboratory results, diagnostic studies, and specialist reports to identify relevant mortality and morbidity risks.
- Read and interpret EKG/ECG results and other diagnostic testing to support underwriting and claims assessments.
- Provide ongoing education and medical consultation to underwriters, claims examiners, and other business partners through case discussions, medical referrals, and coaching.
- Lead and contribute to the development, review, maintenance, and enhancement of underwriting medical manuals, guidelines, and reference materials to ensure alignment with current medical evidence and insurance medicine best practices.
- Maintain expert-level knowledge of medical literature, clinical developments, treatment advances, and emerging trends relevant to insurance medicine and risk assessment.
Benefits
- Competitive salaries
- Incentive and bonus opportunities
- Bonus target or Variable Incentive Compensation component
- Extensive benefits offerings
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What This Job Offers
Job Type
Full-time
Career Level
Senior
