Job Summary: Analyst responsible for reviewing and evaluating strategic medical claims, analyzing inconsistencies, posting and implementing claim denials, and ensuring process improvement. Key Highlights: 1. Challenging position focused on analysis and continuous process improvement. 2. Opportunity for those who enjoy learning and embracing challenges. 3. Interaction with accredited providers to address pending issues and provide guidance. If you possess strong interpersonal skills, enjoy learning, and are willing to embrace challenges, this position is for you! Position to cover maternity leave. **Responsibilities and Duties** * Review and evaluate medical claims related to the portfolio of accredited providers classified as “strategic” due to complexity, billing volume, or relevance to the company; * Analyze data inconsistencies using contractual tables to prevent improper charges and payments; * Post approved “Strategic” medical claims into the automated system, finalize the appropriate process closure, and forward them to the responsible payment department; * Contact accredited providers from the “Strategic” portfolio or other internal departments to address pending items and/or discrepancies, providing guidance for necessary corrections and resubmission for processing (when required), thereby enabling process completion; * Implement claim denials in the automated system when data or cost discrepancies are identified following claim analysis, entering observations regarding denial reasons directly into the system to ensure process completion and communication to the accredited provider; * Prepare and submit biweekly or monthly Denial Reports to Immediate Supervision to support monitoring of medical claims processing; * Identify opportunities for systemic and/or procedural improvements to ensure better operational performance and improved financial results for the company. * Adhere to specific schedules, observing respective deadlines and essential procedures required for process closure; * Understand the health plans offered by PASA – Vale’s Retiree Health Assistance Plan – to support dissemination and clarification of questions about the Association among retirees and employees of Vale Group companies; * Be accountable for the quality, reliability, and performance of resources, services, and information generated by tasks under your responsibility. **Requirements and Qualifications** * Completed high school education; * Proficiency in Microsoft Office suite; intermediate Excel skills preferred; * Experience with automated medical claims processing systems; * Familiarity with health plan fee schedules; * Knowledge of hospital, outpatient, and medium-complexity medical claims processing, with a minimum of 24 months’ experience. **Additional Information** **Additional Information:** * Transportation allowance (VT) provided as needed, with a 4% salary deduction; * Meal allowance (VR) of R$19.90 per workday, with a 5% deduction applied to the amount provided; * Health insurance (policyholder only) with a fixed deduction of R$0.01, under Amil 400 QC National plan; * Life insurance at no cost to the employee. We are an Association in which people can trust—trust their lives, their families, and their future. We are an exclusive benefit offering attentive, high-quality service to everyone who has been or currently is part of Vale. The exclusivity of having more than just a health plan has a name: PASA. Vale’s Retiree Health Assistance Plan (PASA) was established in 1991 to ensure that the company’s retirees and their families continue enjoying top-tier healthcare services. The operator surpassed all expectations and became a successful initiative in the self-managed healthcare segment. Our mission is "**To deliver the best care with the utmost compassion.**" We act in a welcoming manner and strive to ensure all individuals feel safe and confident being part of PASA. Our goal is to enable every person to fully enjoy life without concerns about access to healthcare. Through the joint efforts of over 300 employees, we work to ensure that members and users have access to the most advanced medical innovations at the lowest possible cost, so that PASA continues successfully fulfilling the mission entrusted to it by its visionary founders. Our key objectives for the coming years are: * Caring for people * Leadership in healthcare management * A sustainable institution * Customer at the center