Description: Responsibilities and Activities: * Audit medical and hospital accounts to ensure compliance with regulations, contracts, and pricing schedules, preventing improper charges; * Analyze procedures and authorizations to verify clinical appropriateness and cost-effectiveness; * Issue technical opinions on complex cases, treatments, and requests, aligning corporate decisions with current legislation. * Guide internal teams and clients on healthcare practices, protocols, and fraud prevention, promoting transparency; * Monitor claims indicators and propose strategies to reduce costs without compromising beneficiary care. * Conduct on-site visits and actions at client locations when necessary. 2512170202551924415