Claim Analyst

Description

Job Summary: We are seeking a dedicated, analytical, and solution-oriented professional to join our Claim Appeal team, responsible for identifying, analyzing, and appealing claim denials. Key Highlights: 1. Dedicated, analytical, and solution-oriented professional 2. Teamwork and good interpersonal relationships 3. Attention to detail, agility, and flexibility **POSITION:** Claim Analyst **WORK SCHEDULE:** 44 hours per week **SALARY:** BRL 2,900.00 (initial salary BRL 2,700.00, with an adjustment of BRL 200.00 after the 3-month probationary period) **BENEFITS:** Meal allowance BRL 30.00/day + Transportation allowance + Health insurance with co-payment (available after 6 months) + Birthday leave (after 1 year of employment) + University partnership agreements **JOB DESCRIPTION:** We seek a professional who is **dedicated**, **analytical**, and **solution-oriented** when facing challenges to join our Claim Appeal team. **TECHNICAL REQUIREMENTS:** * Minimum education: Completed high school; * Experience and knowledge of contractual rules and claim appeals; * Proficiency in Simpro and Brasíndice journals, as well as AMB, CIEFAS, CBHPM, SBH, TISS, and TUSS standards; * Proficiency in ANS’s ROL (List of Procedures); * Advanced proficiency in Microsoft Office Suite; * Advanced knowledge of XML files; * Experience with the Tasy system; Experience with health insurance providers and the Zero Glosa platform is a **plus**. **BEHAVIORAL REQUIREMENTS:** * Clear, objective, and assertive written and oral communication; * Teamwork; * Good interpersonal relationships; * Commitment, initiative, and dynamism; * Attention to detail; * Agility and flexibility, working efficiently; * Organizational and planning skills; * Ability to remain calm and productive under high-pressure situations; * Proactivity and persistence. **RESPONSIBILITIES:** * Identify claim denials issued by health insurance providers through payment statements and account analyses; * Analyze claim denials based on contractual rules and Simpro, Brasíndice, SBH, AMB, CBHPM, CIEFAS, TISS, TUSS, DUTs, and authorization guidelines; * Prepare claim appeal documents with supporting evidence and submit them via spreadsheet, website, XML, mail, or other formats requested by the health insurance provider; * Register appeal protocols in the internal system (Tasy/Zero Glosa) and track their payments; * Record errors causing claim denials to guide relevant departments and correct procedures/processes, and notify supervisors for oversight; Plus other duties pertinent to the role. Employment type: Permanent CLT contract Benefits: * Medical assistance * Partnership agreements and commercial discounts * Meal allowance * Transportation allowance Selection question(s): * Are you proficient in Simpro and Brasíndice journals? * Do you have advanced knowledge and skills in XML files and Microsoft Office Suite? Education: * Completed high school (Mandatory) Experience: * Claim appeals and knowledge of contractual rules (Mandatory) Work location: On-site