Medical Director

About the role

Provides medical leadership and oversight across utilization management, cost containment, provider network management, medical operations, underwriting, and claims support to promote quality care, operational efficiency, regulatory compliance, and sustainable claims performance.

Key responsibilities

• Analyze utilization and claims trends, identify cost drivers, and recommend medical cost-containment initiatives. Oversee member steering, telemedicine adoption, chronic disease management, wellness programs, and use of cost-effective provider options.
• Provide medical oversight for Provider Network and Medical Call Center operations to support efficient processes, SLA compliance, proper PhilHealth application, and continuous service improvement.
• Support provider development, accreditation, expansion, performance monitoring, and relationship management. Negotiate service arrangements that promote cost efficiency, service quality, and member experience.
• Set team direction, clarify performance expectations, provide coaching and feedback, and promote accountability, collaboration, and continuous improvement.
• Provide medical evaluation and professional opinion to support underwriting, claims assessment, case resolution, and client or intermediary requirements.
• Monitor utilization and medical spend and recommend actions to support sustainable claims performance and quality care.
• Oversee chronic disease management program implementation to improve outcomes for members with chronic conditions and reduce avoidable claims.
• Develop and manage cost-effective healthcare partnerships to improve access, care coordination, and member steering.
• Ensure timely, accurate, and SLA-compliant medical support for members, clients, intermediaries, and providers.
• Support provider expansion, accreditation, performance monitoring, and relationship management to maintain a reliable and cost-efficient network.

About you

• Doctor of Medicine degree from a recognized medical school.
• Valid Professional Regulation Commission license to practice medicine in the Philippines.
• Minimum of 5 to 7 years of clinical practice, preferably in a specialty relevant to mortality and morbidity risk.
• Leadership experience in managing medical teams or cross-functional initiatives.
• Strong knowledge of healthcare operations, medical risk assessment, claims management, patient safety, and applicable regulatory requirements.
• Strong analytical, communication, decision-making, and stakeholder management skills.
• Postgraduate training in a relevant specialty, an advantage.
• Master's degree in Business Administration, Public Health, Healthcare Management, or a related field, an advantage.
• Experience in insurance medicine, medical underwriting, medical claims assessment, or healthcare operations, an advantage.
• Board certification in a relevant specialty, an advantage but not required.