Medical Coordinator

About the role

We are seeking a Medical Coordinator to deliver an exceptional member experience throughout the healthcare journey. The role involves coordinating medical care, managing Level 0 authorizations, reviewing clinical documentation, and acting as the primary liaison between members, brokers, providers, hospitals, and our internal Case Management team.

Key responsibilities

• Serve as the main point of contact for members from pre‑authorization through hospital discharge.
• Verify eligibility, issue notifications, and process pre‑authorizations and Level 0 medical authorizations within service level agreements.
• Review clinical documentation and apply medical necessity criteria according to company policies.
• Coordinate care with hospitals, physicians, clinics, and providers worldwide to ensure timely service.
• Explain policy benefits, coverage details, deductibles, coinsurance, and member financial responsibilities.
• Provide proactive follow‑up to members, families, brokers, and providers during hospitalizations and ongoing treatments.
• Escalate complex clinical cases to the Medical Evaluator with complete documentation.
• Negotiate provider fees and promote cost‑effective treatment options while maintaining quality of care.
• Identify and report potential fraud, waste, or abuse in line with company procedures.
• Maintain accurate case documentation, authorizations, and clinical records in internal systems.
• Collaborate with multidisciplinary teams to ensure continuity of care, regulatory compliance, and an outstanding member experience.
• Support quality improvement initiatives, audits, and operational projects.

Required profile

• Bachelor’s degree in a health‑sciences field such as Nursing, Medicine, Healthcare Administration, Social Work in Healthcare, or a related discipline.

Required skills