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Medical Auditor
Grupo Fácil. Conduct online eligibility assessments and authorize medical procedures in accordance with the guidelines and policies of client health plans.
About the role
Key responsibilities & impact- Conduct online eligibility assessments and authorize medical procedures in accordance with the guidelines and policies of client health plans.
- Issue well-founded technical opinions for elective, urgent, and emergency procedure requests during business hours through a dedicated information system.
- Review requested procedures with a high degree of accuracy, based on sound medical criteria and applicable regulations.
- Ensure the confidentiality and integrity of medical information and patient records, in compliance with the company’s and client health insurers’ LGPD requirements throughout the audit process.
Requirements
What you’ll need- Bachelor’s degree in Medicine.
- Active and unrestricted registration with the relevant professional medical board (CRM), supported by a certificate of good standing from the professional council.
- Completed postgraduate qualification in Medical Auditing, with at least two (2) years of proven professional experience in the field.
- Relevant and diverse clinical experience across different medical specialties.
- Active CNPJ (Brazilian corporate tax registration).
- Strong knowledge of medical guidelines, clinical procedures, reimbursement tables (e.g., AMB), and TUSS terminology.
- In-depth familiarity with ANS regulations, preparation of technical opinions, and health plan operating policies.
- Strong analytical skills to critically, impartially, and decisively review medical information.
- Impeccable ethical standards and strict confidentiality when handling sensitive information.
- Excellent ability to manage deadlines and priorities in a dynamic, high-demand environment.
- Strong professional commitment, discipline, and organizational skills to work remotely.
- Collaborative approach and ability to work effectively with other healthcare professionals.
- Excellent written and verbal communication skills.
- Basic computer skills and the ability to adapt easily to new management systems.
Benefits
Comp & perks- Remote work
- Contractor engagement under a PJ arrangement
- Business-hours schedule
- Affirmative opportunity for LGBTQIA+ people
- Affirmative opportunity for Black people
- Affirmative opportunity for Indigenous people
- Affirmative opportunity for people aged 40 and over
- Affirmative opportunity for women