Medical Review Physician

Description

Position Summary: We are seeking a Medical Review Physician for the insurance sector with administrative vision and experience in Major Medical Expenses (MME) to ensure efficiency and transparency in hospital care. Key Highlights: 1. Management control and medical auditing to mitigate overspending and fraud 2. Strategic negotiation and optimization of hospital stays 3. Ensuring proper integration of internal medical records and quality of care **MEDICAL REVIEW PHYSICIAN – INSURANCE SECTOR (MME)** ------------------------------------------------- ### **GNP Seguros \| CDMX** Are you a physician with administrative vision and experience in the insurance sector? At **GNP**, we seek your talent to ensure efficiency and transparency in hospital care for our insured members. ### **Your Challenges (Main Responsibilities)** * **Management Control:** Generate and supervise hospital reviews using expense management protocols. * **Medical Auditing:** Identify overspending, potential fraud, or non-covered expenses to prevent improper payments. * **Strategic Negotiation:** Manage medical care in cases where liability must be assumed under policies from other insurance lines. * **Stay Optimization:** Collaborate with treating physicians to design treatment plans for prolonged hospital stays to mitigate costs. * **Compliance:** Ensure proper integration of internal medical records to guarantee quality customer care. ### **Essential Requirements** * **Education:** Bachelor’s degree in Medicine (**Degree and Professional License Required**). * **Experience:** Insurance sector (Major Medical Expenses – MME) and internal hospital processes. * **Knowledge:** Profile of a **Medical Review Physician**, healthcare services, and administrative processes. * **Certification:** Administrative process certification is desirable. * **Availability:** To work in the Coyoacán area and **rotate shifts starting from the 3rd month**. ### **Work Location and Schedule** * **Location:** Av. Cerro de las Torres 395, Campestre Churubusco, Coyoacán, CDMX. * **Work Modality:** On-site with shift rotation availability. ### **Our Offer** * **Base Salary:** $24,425\.00 monthly. * **Statutory Benefits.** * **Benefits Beyond Statutory Requirements** (Life insurance, vouchers, savings fund, etc.). * Job stability at one of Mexico’s most important insurance companies. If you are interested and meet the requirements, apply and we will contact you. **Contact via WhatsApp 55 45x 84\.13\. 50\.** "Our Organization guarantees equal opportunity treatment and non-discrimination in the Talent Attraction process among Men, Women, and Persons with Disabilities"