Medical Director

At Allstate, great things happen when our people work together to protect families and their belongings from life’s uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers’ evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection. Job DescriptionThe Medical Director is a highly experienced medical professional responsible for providing clinical expertise, oversight, and strategic guidance across medical management functions. This role supports complex clinical decision-making including appeals, rescissions, and grievance reviews, while also partnering with legal, product and actuarial teams.In addition, this role contributes to advancing innovation within Medical Management, including supporting the adoption of artificial intelligence (AI) and process improvements to enhance the efficiency, accuracy, and scalability of misrepresentation and clinical review processes. The position proactively partners with cross-functional teams to help move initiatives forward and maintain alignment on priorities, timelines, and expected outcomes.KEY RESPONSIBILITIESProvides clinical oversight and governance for the medical review program, including appeals, rescission, and grievance panel processesConducts comprehensive clinical reviews for first and second-level appeals, including Department of Insurance (DOI) complaintsEvaluates complex medical cases to ensure consistency with policy provisions, clinical guidelines, and regulatory requirementsProvides expert clinical judgment in high-risk or sensitive determinationsProvides independent clinical judgement in support of coverage determinations, free from claims or financial influenceSupports alignment and consistency across appeal outcomes and internal review processesLeads clinical evaluation and decision-making for rescission cases and member grievancesEnsures appropriate application of underwriting intent and policy interpretation in misrepresentation reviewsPartners with legal on complex or escalated casesPartners with legal to ensure compliance with applicable state and federal requirements governing adverse benefit determinations, grievance processes, and clinical review standardsDocuments clinical rationale supporting determinations in a manner suitable for regulatory review, audits and litigationIdentifies opportunities to improve upstream underwriting and risk selection practicesSupports quality assurance and consistency of TPA decision-makingPartners with product management and actuarial teams to inform product design and risk selection strategiesIdentifies trend and provides clinical insight on emerging risks, market trends, and competitive positioningContributes to and helps advance initiatives to integrate AI and/or automation into medical review workflowsProactively identifies and raises opportunities to streamline processes and improve efficiencyPartners with stakeholders to help maintain alignment on priorities, timelines, and expected outcomesEDUCATION AND EXPERIENCE4 year Bachelors Degree (Required)MD or DO (Required)8 or more years of experience  (Required)Clinical experience appropriate to the conditions under review, including ability to perform peer-level review of medical necessity and pre-existing condition determinationsCERTIFICATIONS, LICENSES, REGISTRATIONSActive and unrestricted license to practice medicine (Required)FUNCTIONAL SKILLSExperience working with health insurance preferredMS Word, PowerPoint and Excel spreadsheet skillsTraining and education skillsEffective communication skills, verbal and writtenAbility to handle shifting prioritiesEffective presentation skills including the ability to present complex medical risk informationTECHNOLOGY REQUIREMENTSAllstate provides a comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse. Employees eligible to work from home also receive a monthly connectivity reimbursement to help offset internet costs.When working from home, you must have a dedicated, private workspace free from distractions, along with appropriate desk and seating. Reliable internet is required, with minimum speeds of 50 MB download and 5 MB upload.SkillsClinical Decision Support (CDS), Clinical Review, Medical Management, Process Improvements, Regulatory Requirements, Regulatory ReviewsCompensationCompensation offered for this role is 167,500.00 - 229,750.00 annually and is based on experience and qualifications.The candidate(s) offered this position will be required to submit to a background investigation. Joining our team isn’t just a job — it’s an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. One where you can shape the future of protection while supporting causes that mean the most to you. Joining our team means being part of something bigger – a winning team making a meaningful impact.Allstate generally does not sponsor individuals for employment-based visas for this position.Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component.For jobs in San Francisco, please click “here” for information regarding the San Francisco Fair Chance Ordinance.For jobs in Los Angeles, please click “here” for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance.To view the “EEO Know Your Rights” poster click “here”. This poster provides information concerning the laws and procedures for filing complaints of violat