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.