Medical Director at Allstate

Job description

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 Description This role is part of Allstate's Health Solutions business and supports clinical decision-making across health insurance products and medical management programs. The Medical Director is a highly experienced physician responsible for providing clinical expertise, oversight, and strategic guidance across medical management functions within Allstate's Health Solutions organization. This role supports complex clinical decision-making, including appeals, rescissions, grievance reviews, and Department of Insurance (DOI) complaints, while partnering closely with legal, product, underwriting, actuarial, and operational 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 drive initiatives forward and maintain alignment on priorities, timelines, and expected outcomes. As a Director, you won’t just deliver results – you drive our culture and shared purpose. You can work remotely and will commute to a nearby office and/or travel for meaningful connection opportunities. KEY RESPONSIBILITIES Provides clinical oversight and governance for the medical review program, including appeals, rescission, and grievance panel processes. Conducts comprehensive clinical reviews for first- and second-level appeals, including Department of Insurance (DOI) complaints. Evaluates complex medical cases to ensure consistency with policy provisions, clinical guidelines, and regulatory requirements. Provides expert clinical judgment in high-risk or sensitive determinations. Provides independent clinical judgment in support of coverage determinations, free from claims or financial influence. Supports alignment and consistency across appeal outcomes and internal review processes. Leads clinical evaluation and decision-making for rescission cases and member grievances. Ensures appropriate application of underwriting intent and policy interpretation in misrepresentation reviews. Partners with legal and compliance teams on escalated cases, regulatory matters, litigation support, and interpretation of state and federal requirements impacting clinical review activities. Documents clinical rationale supporting determinations in a manner suitable for regulatory review, audits, and litigation. Identifies opportunities to improve upstream underwriting and risk selection practices. Supports quality assurance and consistency of Third-Party Administrator (TPA) decision-making. Partners with product management and actuarial teams to inform product design and risk selection strategies. Identifies trends and provides clinical insight on emerging risks, market trends, and competitive positioning within the health insurance industry. Contributes to and helps advance initiatives that integrate AI and automation into medical review workflows. Proactively identifies opportunities to streamline processes and improve operational efficiency. Partners with stakeholders to maintain alignment on priorities, timelines, and expected outcomes. Serves as a clinical subject matter expert and trusted advisor to internal business partners on medical management and policy-related matters. SUPERVISORY RESPONSIBILITIES This job has supervisory duties. EDUCATION AND EXPERIENCE Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited institution