Audit Assistant (Authorizations)

Description

This opportunity is to work alongside the **Operations Audit** team, focusing on problem resolution, continuous improvement, and integration across various areas of the cooperative. Key responsibilities include: * Develop and monitor internal controls, ensuring effectiveness and quality in processes; * Track performance indicators, ensuring achievement of established targets; * Contribute to the continuous improvement of operational processes; * Act as a liaison point between departments, promoting alignment and efficiency; * Support initiatives aimed at customer and physician-cooperator satisfaction. **Responsibilities and duties** * Review authorization requests received via the Unimed portal, website, in-person service, call center, etc.; * Monitor deadlines and targets for authorization requests; * Stay updated on cooperative processes to effectively perform daily tasks; * Conduct preliminary evaluation and validation of authorization requests, identifying administrative issues such as claim denials, waiting periods, medical reports, and required documents through data entered in the request form and system (TOTVS), preventing improper authorizations; * Verify health plan coverage for beneficiaries, approving or denying authorizations in a timely manner using the TOTVS system; * Register authorizations in the Health Plan Management System; * Contact beneficiaries, cooperators, and providers by phone to convey necessary information—including denials, authorizations, medical board decisions, and document requests; * Report the need to correct system configuration to prevent improper authorizations; * Handle authorization requests from customers, providers, and other Unimed affiliates; * Identify alternative solutions to resolve inquiries, aiming to satisfy the end customer, providers, and the cooperative; * Clarify doubts with provider networks, other contracted companies, and provide support to other organizational areas regarding authorizations; * Actively contribute to projects aligned with the company’s and department’s strategy. * Support and resolve operational demands hindering smooth audit processes; * Monitor and schedule meetings for the Area Manager to address Unimed, hospital, and cooperator needs related to Medical Audit. * Prioritize and handle other demands from Unimed departments concerning authorizations/denials of medical audit procedures and exams. **Requirements and qualifications** **Education required for this position:** * Completed high school education. **Desired qualifications:** * Intermediate-level proficiency in Excel; * Knowledge of current legislation issued by ANS (National Supplementary Health Agency); * Currently pursuing or completed undergraduate degree in Administration, Business Processes, or related fields; * Currently pursuing or completed postgraduate degree. **Additional information** **We are a team passionate about caring for people — and we do it with purpose, delivery, and sparkle in our eyes!** We are the **2nd best company in the GPTW Health Ranking and the 5th best company to work for in Rio Grande do Sul (RS)**! **And more:** this year, we ranked **45th in the GPTW BRAZIL Ranking!** All this reflects an outstanding workplace climate built by people who believe in what they do! **Join us in achieving even more!** PROUD TO BE GPTW RS, BRAZIL AND HEALTH! **A cooperative with over 50 years of history, market leader in the capital city of Rio Grande do Sul, the Metropolitan Region, Central-Southern region, and Northern Coast of Rio Grande do Sul.** We stand out for the health solutions we offer, serving over **650,000 lives, with 6,900 physician-cooperators and 370 service points**, including both owned and accredited facilities. Our operations are possible thanks to **our employees — professionals who always place care first** and choose **Unimed Porto Alegre to develop their careers.** **We operate guided by 5 pillars**, reflecting how we act daily: Strength and tradition in healthcare Proximity Sense of pride and belonging Care in constant evolution Encouragement of development **We value building close and healthy relationships based on collaboration to find solutions and achieve results.** Challenges are part of our daily routine. Our **dynamic environment enables employees to participate in diverse projects** and **continuously develop.** We take **pride in our purpose** and the **positive impact** we generate in the **lives of thousands of people.** We aim to make **a difference in care** — and we know this is achieved through **welcoming, attention, and constant improvement.** **Come empower your talent and your care. Join Unimed Porto Alegre!**