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Medical Director (Appeals)
Posted Sep 8, 2026 · We last checked this listing on Oct 6, 2026
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Likely interview questions for this role
Written from this job description, not a generic list. Each one notes what the interviewer is really checking.
About your past
You have five years of clinical practice. What made you want to move into managed care, and what do you expect to miss?
What they are checking: Whether they have made peace with reviewing charts instead of treating patients and understand the role honestly.
Tell me about a time you disagreed with a colleague on a clinical decision. How did it resolve?
What they are checking: Whether they can disagree based on evidence without making it personal, which happens often among reviewers.
This is a remote role with electronic case documentation. How do you stay focused and accurate reviewing records all day from home?
What they are checking: Self-discipline and accuracy habits when working alone on high-volume, detailed review.
What would you do
You are reviewing an appeal and the treating physician's notes are strong, but the request does not meet our medical policy criteria. How do you decide?
What they are checking: How they balance policy consistency with clinical judgment and when they would flag a policy that may be out of date.
How would you handle a peer-to-peer call with a frustrated specialist who believes a denial is hurting their patient?
What they are checking: Whether they can stay respectful and clinical with providers while still explaining a decision clearly.
The posting mentions cardiology, oncology and rheumatology. How do you handle an appeal in a specialty outside your own board certification?
What they are checking: Whether they know the limits of their expertise and use specialty matched reviewers or literature rather than guessing.
Appeals have regulatory turnaround times. How would you manage a heavy queue when some cases are expedited?
What they are checking: Whether they understand that urgent appeals have strict clocks and can triage without cutting corners.
About the work
This role focuses on appeals. Walk me through how you review an appeal of a denied service from start to decision.
What they are checking: Whether they read the full record, apply the stated medical policy, and document a decision that would hold up on external review.
How do you write the rationale on an appeal decision so that the member, the provider and a regulator can all understand it?
What they are checking: Clear written documentation, since appeal letters are read by non-clinicians and reviewed in audits.
How do you keep current with medical evidence so that the policies you apply reflect current standards of care?
What they are checking: Whether they read guidelines and literature actively, which matters when policy criteria lag behind practice.
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As published by Health Care Service Corporation.
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