**Job Overview:** * Preparing reports; * Verifying documentation; * Monitoring and tracking medical and dental reimbursement requests; * Communicating with accredited networks, laboratories, physicians, and beneficiaries; * Analyzing and identifying charges inconsistent with agreements and service contracts signed with the health plan operator; * Receiving and processing appeals regarding provider claim denials or beneficiary reimbursements, conducting analyses based on justifications provided; * Analyzing daily hospital rates and fees according to regionally agreed-upon tables; * Analyzing physician fees and SADT (Specialized Diagnostic and Therapeutic Services), in accordance with AMB, CIEFAS, CBHPM, and ANS lists; * Analyzing medical supplies, per Simpro table; * Analyzing medications, per Brasíndice table; * Analyzing OPME (orthoses and prostheses), based on invoices and contractually agreed commercial margins; * Verifying compliance with TISS standards for forms and electronic billing (XML); * Checking TISS form field completion against ANS-established standards; * Supporting system updates for tables (Simpro and Brasíndice); * Coding procedures submitted in reimbursement claims, based on descriptions provided by the professionals who rendered the services; * Analyzing dental fees per RHOUS table and ANS list; * Analyzing and calculating medical, hospital, and dental expense reimbursement requests, per current operator contracts and applicable fee schedules; * Providing support and clarification regarding routines, required information, or technical/operational questions related to the area, for internal or external departments; * Supporting responses to ombudsman or NIP inquiries related to the department. **Requirements:** * Experience in the field; * Completed undergraduate degree; * Knowledge of ANS resolutions, regulations, and official list; * Intermediate Excel proficiency; * Experience in medical-hospital bill analysis and billing; * Familiarity with the Fácil system is desirable; * Familiarity with SBH, AMB, CIEFAS, and CBHPM tables; TISS/TUSS coding; TISS-standard XML; Simpro and Brasíndice tables. **Working Hours:** 8:30 AM to 5:30 PM (Monday through Friday) Employment Type: Permanent CLT Salary: BRL 3,735.00 per month Benefits: * Health insurance * Dental insurance * Life insurance * Meal allowance * Transportation allowance