Administrative Nurse Auditor (Pleno)

Description

Job Summary: Medical Billing Auditor specializing in utilization review, health management, report preparation, and customer support, aiming for optimization and control. Key Highlights: 1. Detailed analysis of medical bills and high-cost users 2. Customer support and resolution of inquiries 3. Preparation of health management reports and indicators Conduct medical billing audits, as well as audits of the highest-cost users, analyzing utilization in detail to identify inconsistencies related to amounts and quantities. Provide high-quality customer assistance broadly, offering support and resolving potential questions. **Responsibilities and Duties** * Support in conducting PRE- and POST-event audits; * Analysis of High-Cost Users; * Prepare health management reports; * Assist the negotiation team, management reporting, and studies with beneficiary utilization data; * Support the development of sinistrality-related indicators and charts for committees; * Support the execution of Special Studies; * Conduct PRE- and POST-event audits; * Send e-mails to the insurer raising questions regarding utilization doubts/re-audits; * Analysis of High-Cost Users; * Prepare health management reports; * Assist the negotiation team, management reporting, and studies with beneficiary utilization data; * Develop sinistrality-related indicators and charts for committees; * Special Studies; * Respond to questions regarding ROL DA ANS coverage and DUTs; * Conduct and review PRE- and POST-event audits, and mediate technical discussions with insurers while clarifying customer questions; * Send e-mails to the insurer raising questions regarding utilization doubts/re-audits; * Conduct and review High-Cost User Analysis; * Prepare, validate, and present health management reports to committees; * Assist the negotiation team, management reporting, and studies with beneficiary utilization data; * Develop sinistrality-related indicators and charts for committees; * Conduct and review Special Studies; * Train new employees; * Understand and manage the client (in cases of dedicated nurses) according to the defined service proposal; * Evaluate hospital admission password release processes with the health insurer; * Provide daily customer service, addressing health needs and demands, and supporting customers in meetings with health insurers or health-support providers (clinical and/or occupational), when strategy relates to health management; * Offer customer support for tool usage – Power BI **Requirements and Qualifications** Intermediate or advanced Excel proficiency Minimum 2 years’ experience in health management + innovative and strategic vision for improvements **Additional Information** **Benefits** * Medical Assistance; * Dental Assistance; * Meal Allowance or Food Allowance; * Transportation Allowance; * Life Insurance; * Profit and Results Sharing; **In Addition to These Benefits, We Offer** * Birthday day-off; * Pharmacy card; * Benefits Club (diverse partnerships with exclusive discounts); * Sesc partnership; * Discount on our products (insurance); * Discount on movie tickets; * Total Pass (Gym Partnership); * Conexa – Strengthening emotional balance We are a global fintech that **unites people and technology to deliver personalized solutions** in insurance, reinsurance, benefits, cybersecurity, and other areas. In Brazil, our story began with the acquisition of It’sSeg Company. Today, we are stronger than ever, combining **intelligence, data, and close relationships** to deliver sustainable results. **Our way of working:** We rank among the leading insurance brokerage and consulting firms in the country, driven by **curiosity, strategy, and collaboration**. We believe the best outcomes stem from teamwork and a constant pursuit of innovation. Here, you’ll find opportunities to **grow, learn, and transform**. We respect your background and experiences, and believe an **inclusive and welcoming environment** adds value to our business. If all this resonates with you, join our story!