LUMA's mission is to ensure our members live healthier, longer lives by providing them brilliantly simple insurance plans. We provide a range of simple, smart policies to global residents, expatriates, local nationals and groups of all sizes. At LUMA, we continuously adopt new innovations to make insurance easy to understand and easy to use.
The Medical Consultant is responsible for providing medical expertise to support underwriting decisions and claims management. The role ensures that medical risk is appropriately assessed, claims are medically justified, and company policies align with best medical practices and cost efficiency.
Responsibilities
1. Underwriting & Risk Assessment
- Assess medical risk and provide recommendations on policy underwriting decisions
- Develop and maintain medical underwriting guidelines and criteria
- Support Sales and Operations teams in evaluating complex medical cases
2. Claims Review & Governance
- Review and validate medical claims for accuracy, necessity, and policy compliance
- Provide medical opinions on complex or disputed claims
- Approve or recommend denial of claims based on medical evidence
- Ensure consistency and fairness in claims decisions
- Be involved and manage meetings with members, treating doctors and partnered companies
3. Medical Policy & Cost Management
- Define and implement medical protocols, exclusions, and coverage guidelines
- Support cost containment strategies while maintaining quality of care
- Recommend appropriate treatment pathways for cost-effective care
4. Knowledge Sharing within Teams
- Deliver training to internal teams (Medical, Claims, Customer Service) on: Medical conditions and treatments, Policy exclusions (e.g., dental, vision, pharmacy), Claims assessment principles
5. Network & Provider Collaboration
- Support the development of hospital and provider networks
- Provide input on provider quality and treatment standards
- Collaborate with network teams to optimize care quality and cost
- Develop professional relationships and collaborative agreement with senior hospital executives and key physicians, both in private and academic hospitals
6. Compliance & Quality Assurance
- Ensure adherence to medical ethics, regulations, and insurance policies
- Maintain confidentiality of medical information
- Stay updated on medical advancements and healthcare regulations
Qualifications
- Experience: Bachelor's degree in Medicine (M.D. or equivalent) with a minimum of 5 years of experience in medical practice and the health insurance industry.
- Communication Skills: Native English speaker is preferred. Any other language is a plus.
Benefits
- Competitive package
- 12 days of annual leave per year
- Social Security
- Provident Fund
- Medical Insurance
