“Work for a health insurance company? You mean go to the dark side? No thanks!”
This is what I hear a lot from my clients who are considering a non-clinical career. However, with the way things are going in medicine, some are reconsidering. They are willing to temporarily suspend judgment to at least learn about this area. What they are finding out is the dark side is not necessarily so dark after all.
To get the inside scoop, I interviewed one of my awesome clients who generously agreed to share her experience working for a major health insurer. For the purpose of this interview, I will refer to her as Dr. Crawford (not her real name).
Background: Dr. Crawford is board certified in internal medicine and practiced for over 10 years before transitioning into the health insurance industry.
HF: What is a typical workday like for you?
Dr. Crawford: I work from home, usually 8 am – 5 pm. I take an hour off for lunch. My work focuses on Medicare inpatient claims. I participate in case management rounds. These are generally for chronically ill patients that are in the hospital a lot. Nurses prep the information for me and we do rounds on the phone. A lot of times there are crazy social issues. There was a patient who had some medical and psych issues. The hospital tried to place him in 40 skilled nursing facilities to no avail, as no one would accept him due to behavioral issues. We had to push the case managers at the hospital to get him a guardian since his family was not caring for him. Finally they were able to place him in a nursing home. I also do some appeals for cases that have been denied and a few pre-certifications.
HF: Are you required to go into an office at all?
Dr. Crawford: No. I don’t go into an office. Instead, there are occasional meetings in surrounding cities where I learn about new Medicare policies and anything that affects my workflow. This is when I see my other team members. I work with 2 family practitioners and one oncologist.
HF: How do you deal with doctors who are angry because you are questioning their treatment plan or denying something?
Dr. Crawford: I tell them I understand your frustrations and how with discharge plans social issues can get in the way. I don’t always nitpick down to the minute criteria. I let them know I understand that these things can come up with older folks, that I used to take care of them. It is only rarely that I have to speak to doctors who are upset. I’ve probably had 2 in the past 10 months. Of my cases, only about 10% require a peer-to-peer where I need to speak to the physician. One guy threatened to sue me personally for my decision. I said OK I am going to end this call because you are repeatedly threatening me and let him know of his right to appeal the decision.
HF: What do you like about your job?
Dr. Crawford: I love working at home. I like my team. I like my superiors and the management structure of the company. They take your concerns into consideration and try to make it work for you. The benefits and pay are really good. I enjoy getting to use my medical knowledge. It’s not a simple job, but there is so much less stress than when I was in clinical practice.
HF: What don’t you like about your job?
Dr. Crawford: There is a lot of typing and mousing. I was having trouble with my wrists before and I still do…I get up and take some breaks and move around.
HF: How are you treated?
Dr. Crawford: Really well. In my last job I was a corporate employee. This is vastly different experience. I was warmly welcomed. I have one-on-one meetings with my boss. When I was in practice as a corporate physician, they always forgot Doctor’s Day. This year I received 42 Happy Doctor’s Day emails. It’s a much better feeling.
HF: What kind of compensation could a doctor anticipate for an entry-level position?
Dr. Crawford: $200 – $220K. There are lots of good benefits. We have a nice 401K match, annual raises, a generous yearly bonus. Health insurance, dental, disability, some employee discounts. EAP. Financial counseling. 23 days PTO, 5 days CME, CME stipend and malpractice coverage
HF: What advice would you give other doctors who are interested in working for a health insurance company?
Dr. Crawford: I would not discount it based on any preconceived notions about insurance companies. I have always felt that the criteria they have is based on sound medical evidence. It made sense to me. I found it to be clinically sound and sensible. I never thought, “I can’t believe they are doing this.” My boss is always telling me, if there is any question in your mind, always err on the side of the patient.
HF: What are the opportunities for advancement?
Dr. Crawford: I could move up and become a senior medical director and then a regional medical director. I don’t think I want my boss’s job. There is a lot of HR you have to do in addition to regular job. They are big on career development. You have two reviews a year and you need to write down your goals and how you will accomplish them. They suggest you find a mentor in the company for support and guidance. One other area that medical directors can be involved in is the medical policy department.
HF: Do you see yourself doing this job long term?
Dr. Crawford: Yes I hope I can do this until I retire.
HF: What kind of doctor would make a good fit for this kind of work?
Dr. Crawford: Anyone who would appreciate the lifestyle improvement and doesn’t need to continue clinical care. There are all specialties. As long as they maintain board certification. We have a lot of primary care physicians, including pediatricians, as well as OB/Gyns, an anesthesiologist, a spine surgeon, one neurosurgeon, a dentist, and a pharm D.
HF: What kind of doctor would not be a good fit for this kind of work?
Dr. Crawford: One who wants to be clinical or who is not a team player.
HF: How is this job different than you expected?
Dr. Crawford: Much better than expected. Great company. They take their employees’ concerns into consideration. They have their HR stuff straight. There are less issues than at my last company. I have not found anything wrong in their policies.
HF: How much do you enjoy the work you are doing?
Dr. Crawford: It is not always the most intellectually stimulating, but I am reading medical cases, and applying the criteria. I get to use my medical brain. I won’t say I am passionate about it. But it is doable and easy.
HF: Do you miss anything from your previous work as an internal medicine physician?
Dr. Crawford: No!!!!!!!!!!
Dr. Crawford’s job focuses on Medicare patients in the hospital setting. A physician working for the commercial side of insurance, and with outpatients, will have different duties. For those interested in applying for a health insurance position, the general requirements are 3 – 5 years clinical experience, active licensure, and board certification. It is helpful to have some type of utilization review or management experience, but this may not be necessary.
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