Claim Denial Analyst

Description

Job Summary: We are seeking a committed, analytical, and solution-oriented professional to join our Claim Denial Appeal team, responsible for identifying, analyzing, and appealing health insurance provider claim denials. Key Highlights: 1. Professional committed, analytical, and solution-oriented 2. Worked on the Claim Denial Appeal team 3. Analysis and preparation of claim denial appeals **POSITION:** Claim Denial Analyst **WORK SCHEDULE:** 44 hours per week **SALARY:** R$ 2.900,00 (initial salary R$2.700, with R$200 adjustment after the 3-month probationary period) **BENEFITS:** VA R$30.00/day + VT + Health insurance with co-payment (after 6 months) + Birthday Day Off (after 1 year) + University partnership agreements **JOB DESCRIPTION:** We seek a **committed**, **analytical**, and **solution-oriented** professional when facing challenges to join our Claim Denial Appeal team. **TECHNICAL REQUIREMENTS:** * Minimum education: Completed high school; * Experience and knowledge of contractual rules and Claim Denial 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 knowledge and skill 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, concise, and assertive written and oral communication; * Teamwork; * Strong interpersonal skills; * 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 denial appeals with supporting documentation and submit them via spreadsheet, website, XML files, postal mail, or other formats requested by the health insurance provider; * Register appeal protocols in our 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 monitoring purposes; And other duties pertinent to this position. Employment Type: Permanent CLT Benefits: * Medical assistance * Partnerships and commercial discounts * Meal allowance * Transportation allowance Selection Question(s): * Do you have proficiency in Simpro and Brasíndice journals? * Do you have advanced knowledge and skill in XML files and Microsoft Office Suite? Education: * Completed high school (Mandatory) Experience: * Claim Denial Appeals and knowledge of contractual rules (Mandatory) Work Location: On-site