Clinical Adviser

Position Title: Clinical Adviser

Location: Makati City

Employment Type: Contractual (once or twice a week)

Job Summary:

The Clinical Adviser provides expert medical advice and guidance to support the company's underwriting, claims, and product development functions. This role is responsible for reviewing and validating medical documentation, interpreting clinical data, and ensuring that all health-related decisions align with current medical standards, regulatory requirements, and company policies. The Clinical Adviser also plays a key role in policy design, stakeholder engagement, and medical training initiatives.

Key Roles and Responsibilities:

1. Medical Expertise and Advisory

• Provide clinical guidance and professional medical opinion on health-related cases, particularly for complex or high-value claims.
• Review and validate medical reports, diagnostic results, and clinical documentation from clients, healthcare providers, and hospitals.
• Ensure all health recommendations are consistent with established medical standards and best practices.

2. Case Review and Support

• Assist underwriting and claims teams in determining medical eligibility, exclusions, and policy limitations.
• Review declarations on pre-existing conditions or chronic illnesses during application or renewal.
• Offer second opinions or clarifications on disputed or questionable medical cases.

3. Policy and Product Development

• Collaborate with product development teams to design or enhance health insurance benefits, wellness programs, and corporate health plans.
• Recommend appropriate medical inclusions, exclusions, and clinical justifications during product design stages.

4. Stakeholder Engagement

• Liaise with healthcare providers, third-party administrators (TPAs), and hospital networks for medical clarifications and case coordination.
• Participate in client meetings or presentations to provide clinical rationale and support business development.

5. Compliance and Quality Assurance

• Ensure all medical reviews comply with local health regulations, ethical standards, and internal policies.
• Conduct periodic audits of claims and clinical decisions to enhance process efficiency and quality.

6. Training and Support

• Train internal teams (claims, underwriting, and client servicing) on basic medical terminology, red flags, and clinical protocols.
• Act as an internal resource person for medical education initiatives.

7. Crisis or Pandemic Response

• Provide medical advisories and guidelines during public health emergencies (e.g., COVID-19).
• Monitor emerging health risks and advise management on potential business and operational impacts.

QUALIFICATIONS:

Education:

• Doctor of Medicine (MD) degree, preferably licensed to practice in the Philippines.
• Postgraduate training or specialization in Internal Medicine, Family Medicine, or Public Health is an advantage.

Experience:

• At least 3–5 years of clinical practice in a hospital, clinic, or corporate health setting.
• Experience in health insurance, medical underwriting, or claims assessment is highly preferred.

Skills & Competencies:

• Strong clinical judgment and diagnostic interpretation skills.
• Excellent communication and presentation abilities, with the capacity to explain complex medical concepts to non-medical stakeholders.
• Proficient in reviewing and analyzing medical documentation.
• High ethical standards and commitment to confidentiality.
• Strong interpersonal skills for engaging with internal teams, clients, and external partners.

Other Requirements:

• Updated knowledge of current medical guidelines and public health protocols.

Willingness to travel for stakeholder engagement, training, or client presentations (as required).

Job Type: Part-time

Pay: Php12, Php15,000.00 per month

Expected hours: 8 per week

Benefits:

• Company events
• Flexible schedule
• Flextime
• Life insurance
• Promotion to permanent employee

Work Location: In person