* Responsible for analyzing and controlling medical procedure and service authorization processes, ensuring all obligations are fulfilled in compliance with internal policies, health plan operator regulations, and current legislation. Acts as an interface between patients, service providers, and the health plan operator, guaranteeing timely processing and quality of information handled. Additionally, contributes to continuous improvement of request processes and workflows, consistently pursuing excellence in service delivery and demand management. **Responsibilities and Duties** * Manage office supplies. * Negotiate with OPME suppliers. * Guide the accredited network regarding beneficiary care. * Instruct reception staff on departmental procedures. * Review reimbursement requests. * Provide technical and administrative support to teams involved in authorization processes, clarifying doubts and guiding on procedures. * Train new authorization staff across units. * Interact with medical auditors. * Support the Corporate Relations and Customer Service departments regarding utilization reports and inquiries. * Conduct administrative audits of test, surgical procedure, and hospitalization requests. * Analyze and authorize requests for medical procedures, tests, hospitalizations, and other services, ensuring adherence to internal policies. * Validate documentation and information received from service providers and patients, ensuring completeness and compliance with requirements. * Maintain communication with service providers, health plan operators, and internal departments, ensuring resolution of pending items and appropriate flow of authorization processes. * Serve beneficiaries and their representatives via phone and in person, analyzing and addressing demands to seek solutions aimed at customer satisfaction. * Monitor deadlines and targets for authorization requests. * Verify beneficiaries' health plan coverage, approving or denying authorizations promptly using the operator's system. Receiving authorization requests, registering them in the operator's management system, validating authorization requests by identifying missing information, medical reports, and documents based on data entered in the request form, thereby preventing improper authorizations. * **Requirements and Qualifications** * Strong verbal and written communication skills; * Clear diction; * Ethical; * Committed; * Proficiency in Microsoft Office suite; * Ability to interact with customers empathetically and professionally; * Strong organizational skills and attention to detail; * Customer service experience. ANS usage guidelines. GIH / SADT. Knowledge of specialized therapy and diagnostic tests; * Familiarity with ANS regulations and applicable rules governing the supplementary health sector is a plus; **Additional Information** **Benefits:** Transportation Allowance or Fuel Voucher Attendance Card Health and Dental Plan – employee monthly fee waived Meal Voucher or Food Allowance Annual Bonus based on achieved goals GymPass – access to gyms and wellness services Life Insurance **Working Hours:** 08:00 to 17:48 – MON to FRI We are a strong, experienced group driven by health. The DC Group is a platform of independent brands and services united by a shared purpose: **providing health solutions for people.** **STRENGTH. HEALTH. EXPERTISE.** These three pillars guide our actions. It is from this foundation that our companies grow and increasingly distinguish themselves within their respective fields. With ethics, social commitment, and continuous evolution, we continue promoting quality of life, facilitating and simplifying access to healthcare, and innovating in the management of our processes and services. **We are the DC Group, and here we breathe health.**
João Silva
Indeed · HR
João Silva
Indeed · HR
