Medical Advisor

Description

### **General Information** **Location** Mexico City, Ciudad de Mexico Working Schedule Full\-Time Work Arrangement Hybrid Relocation Assistance Available No Posted Date 22\-May\-2026 Job ID 17860 ### **Description and Requirements** *We are global experts and recognized leaders in insurance. With over 150 years of experience, we deliver top-tier life insurance, lifetime annuities, and employee benefits programs to more than 90 million customers across 50 countries. In Mexico, we are the country’s #1 individual insurer, serving over 10 million insured individuals.* We are seeking a **Medical Claims Evaluator – Major Medical Expense Insurance (VIP Service)**. **PURPOSE OR MISSION OF THE ROLE**: Ensure timely, accurate, and high-service-level medical evaluation for major medical expense claims and authorizations, delivering differentiated, premium service to VIP insured individuals while balancing clinical, contractual, and customer experience considerations. **KEY RESPONSIBILITIES** * Evaluate medical care, hospitalization, surgical, and treatment requests under Major Medical Expense (MME) policies within Direct Payment, Scheduled Surgery, and Reimbursement processes. * Analyze clinical records using medical and contractual criteria. * Provide personalized medical support to VIP insured individuals. * Handle urgent cases effectively and with priority response time. * Coordinate with hospitals, treating physicians, and high-tier providers. * Support resolution of high-impact complaints or disputes. * Issue cost-control recommendations without compromising quality of care. * Anticipate potential conflicts and escalate to senior management as needed. * Ensure timely internal and/or external communication, as appropriate. **REQUIREMENTS AND QUALIFICATIONS** * Licensed Physician and Surgeon (degree and professional license mandatory). * Minimum 3 years of experience in Major Medical Expense (MME) insurance. * Experience in medical expense insurance, medical evaluation, or medical auditing. * Experience serving high-profile or VIP clients (desirable). * Experience managing complex, urgent, and/or high-cost cases. * Technical Knowledge * Comprehensive medical evaluation and evidence-based medicine. * General conditions of major medical expense insurance policies. * Medical authorization and evaluation processes. * Interpretation of clinical records. * Hospital cost structures and provider negotiations. * English (desirable) * Intermediate Office skills: Intermediate Excel, Intermediate PowerPoint, presentation development and delivery, effective communication. * ***SPECIFIC REQUIREMENTS FOR INTERNAL CANDIDATES:*** * ***You must have held your current position for at least 12 months.*** * ***Your most recent performance evaluation rating must be Satisfactory.*** * ***Your manager must be informed prior to your application.*** * ***We will request a confirmation email from you.*** * ***We recommend that you do not apply to two or more processes simultaneously.*** **INTERPERSONAL PROFILE** * Strong customer orientation (premium/VIP profile). * Decision-making under pressure. * Empathy and executive-level interpersonal skills. * Clear and diplomatic communication. * Negotiation ability. * Discretion and handling of confidential information. * Sense of urgency and prioritization. * Work location: Torre Manacar, CDMX * Work arrangement: Hybrid (3 days on-site, 2 days remote) * Schedule: Corporate hours — Monday to Thursday, 08:00–17:30; Friday, 08:00–15:00\) *At MetLife, we are committed to fostering diversity among employees through non-discriminatory treatment based on race, gender expression/identity, sexual orientation, religion, age, nationality, marital status, disability, physical or economic condition. HIV and pregnancy tests are not required for hiring, retention, or promotion, and equal employment opportunities are guaranteed.* We share the link to our Candidate Posting and Application Guidelines. Policy of Job Posting. **Benefits We Offer** Our benefits are designed to support holistic well-being, including programs for physical and mental health, financial wellness, and family support. We offer major medical expense insurance, life insurance, and a competitive compensation package—including performance bonuses, savings fund, and pension plan. We also provide extended parental and adoption leave, plus additional benefits such as volunteer time off, birthday leave, Cultural Heritage Day, cultural and sports events—and much more! **About MetLife** Named to Fortune magazine’s 2025 list of the “World’s Most Admired Companies” and ranked among Fortune’s 25 Best Workplaces™ in the World 2025, MetLife—through its subsidiaries and affiliates—is one of the world’s leading financial services companies, providing insurance, annuities, employee benefits, and asset management to individual and institutional customers. Our purpose is simple: to help our colleagues, customers, communities, and the world at large build a safer future. United by purpose and guided by our core values—Win Together, Do the Right Thing, Deliver Impact over Activity, and Think Forward—we are inspired to transform the next century of financial services. At MetLife, it’s \#AllTogetherPossible—join us! At MetLife, we are committed to fostering diversity among employees, through non\-discriminatory treatment for reasons of gender, gender expression, sexual orientation, religion, age, nationality, marital status, disability, physical or economic condition, HIV and embarrassment as a requirement for entry, permanence or ascension and there is equal employment opportunities.