Claims Analyst

Description

Job Summary: Claims Analyst focused on critical analysis of medical, technical, and administrative claim denials, preparation of appeals, and interaction with internal departments. Key Highlights: 1. Make a difference in hospital revenue recovery 2. Work on critical analysis and preparation of administrative appeals 3. Develop yourself in an environment that values care and quality You are applying to our talent pool for positions across Brazil, in locations where Rede Américas operates (Northeast, Central-West, Southeast, and South regions of Brazil). Therefore, please note that as soon as a position matching your profile becomes available, we will contact you. In the meantime, please keep your information updated and complete all online assessment stages so we can learn more about you. ***Important: We do not charge any fees during our selection processes.*** **Responsibilities and Duties** Here, your role makes a difference every day. Review the details about this position: **** * Perform critical analysis of medical, technical, and administrative claim denials received from health insurance providers; * Prepare administrative appeals based on clinical and contractual documentation; * Interact with internal departments (billing, auditing, clinical teams) to validate information and gather supporting evidence for appeals; * Monitor deadlines for submission and response of appeals, ensuring SLA and defined targets; * Track denial and revenue recovery metrics; * Support identification of process improvement opportunities impacting recurring denials; * Stay updated on ANS regulatory standards and health plan guidelines. **Requirements and Qualifications** If you believe that **care** begins with preparation and intention, this may be the right place for you. To **care** with us, it is important to have: * Bachelor's degree in Administration, Nursing, Hospital Management, or related fields; * Prior experience handling hospital claim denials and appeals; * Knowledge of contracts with health insurance providers and procedure fee schedules (TUSS, CBHPM, AMB, among others); * Ability to read and interpret medical records; * Proficiency in Microsoft Office suite (especially Excel); * Experience with hospital information systems (e.g., Tasy, MV, Smart). **Additional Information** Location: **Campinas \- SP** Work Model: On-site Our **care** starts at home, delivering excellence for our people. At Rede Américas, we value those who build **care** daily. That’s why we offer benefits designed for your well-being, development, and quality of life. Check them out: * **Care** for nutrition: meal allowance, food voucher, or on-site cafeteria (depending on the unit); * **Care** for health: health insurance and life insurance; * **Care** for your development: Américas Academy, Development and Career Cycle, Culture Academy, and “Crescer” Program within Rede Américas; * Others: transportation allowance, SESC benefits, and recognition programs. Only at Rede Américas do we offer the “Bem Cuidar” Program, grounded in pillars of physical, mental, and emotional health. Our care pathways are thoughtfully designed for our people’s well-being, promoting healthy habits, preventing illness, and helping reduce stress. Learn more: * Mental and emotional health: specialized psychosocial support and counseling by psychologists, psychiatrists, and social workers, tailored to each individual’s care needs; * Social assistance: remote social support provided by social workers for issues including financial insecurity, health concerns, guidance on social benefits, and others; * For pregnant employees: multidisciplinary follow-up and monthly support groups; * Quality of life: with TotalPass, you gain access to gyms and physical activities at special rates—more health and well-being for your daily life; * Health campaigns: monthly awareness initiatives based on health management data, focusing on prevention and promotion of healthy habits. * Social benefits: our internal policies provide enhanced support and well-being for those who need it most—including persons with disabilities, individuals with Autism Spectrum Disorder (ASD), oncology patients, and pregnant employees. * Benefits may vary depending on the job location and brand. If care is also your passion, this is your place. Apply now and build a career that connects purpose and practice. We are Rede Américas, **a multiplatform healthcare assistance network**, committed to delivering comprehensive, precisely tailored care for health. We are seeking **talents who believe it is possible to deliver the best and most advanced healthcare assistance.** **If you are passionate about caring and believe in quality medicine, join Rede Américas!** **We are committed to Diversity!** We encourage applications from all individuals who recognize the importance of building a prejudice-free, harassment-free, and discrimination-free environment. Together, we always deliver our best. **Important: We do not charge any fees during our selection processes.**