Regulatory Physician

Saúde PASA

. Conduct qualified health interviews with all new members enrolling in PASA health plans, focusing on identifying pre-existing conditions .

Posted 10/20/2026full-timeRio de Janeiro • BrazilMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in pre-existing condition assessment and Temporary Partial Coverage processes, with a strong focus on healthcare regulation, auditing, and system configuration. Proficient in analyzing performance indicators and optimizing workflows to enhance operational efficiency in health insurance settings.

Highest-signal resume keywords

Bachelor's Degree In MedicineActive Medical License (CRM)Pre-Existing Condition AssessmentTemporary Partial Coverage ProcessesHealthcare Regulation And Auditing

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Health Declaration CompletionSystem ConfigurationAuthorization WorkflowsPerformance Indicator AnalysisFraud Identification

Soft Skills

Problem SolvingCommunicationCollaboration

Certifications & Qualifications

Active Medical License (CRM)

Industry Keywords

Health InsuranceHealthcare Performance IndicatorsANS Regulatory StandardsTemporary Partial CoveragePre-Existing Conditions

About the role

Key responsibilities & impact

Conduct qualified health interviews with all new members enrolling in PASA health plans, focusing on identifying pre-existing conditions
Support members in completing the Health Declaration (HD)
Match the completed Health Declaration with the corresponding Temporary Partial Coverage (TPC)
Configure the system with TPC and waiting-period rules
Support the authorization and enrollment teams in matters involving pre-existing conditions, TPC, and waiting periods
Identify potential member fraud by reviewing Health Declarations and procedure requests
Conduct the process of amending the Health Declaration and TPC agreement with members when indicated
Support the definition of technical authorization and audit parameters for procedures covered by health plans and benefits
Analyze and optimize authorization and audit workflows
Prepare and monitor performance indicators and reports for the pre-existing condition and TPC assessment process
Implement and receive productivity reports, converting them into indicator reports for management and the Executive Board
Assess the progress of initiatives, identify inconsistencies, and propose solutions and improvements
Analyze and propose communication, training, and outreach plans for the pre-existing condition and TPC assessment process
Support the Legal and Ombudsman teams with technical matters involving court proceedings, NIPs, and complaints

Requirements

What you’ll need

Bachelor’s degree in Medicine
Active medical license (CRM)
Knowledge of and experience with pre-existing condition assessment and Temporary Partial Coverage processes
Knowledge of health insurer system configuration
Knowledge of claims and healthcare performance indicators
Experience in healthcare regulation and/or auditing
Knowledge of ANS regulatory standards
At least 5 years of experience working for health insurance providers

Benefits

Comp & perks

Meal and food allowance through Swile
Medical and dental insurance, plus group life insurance
Medication assistance and vaccinations
Online psychology and psychiatry services
Telemedicine
Private pension plan (Valia), with employee and employer contributions
Educational assistance for undergraduate and graduate programs
Childcare assistance
Funeral assistance
Christmas benefit
PASA membership and Benefits Club access
Maternity benefit with extended leave of up to 180 days
Paternity benefit with extended leave of up to 20 days
Sesc membership
TotalPass
Performance Bonus Program (PGD), provided the company closes the year with a positive result
Sicoob Coopvale
Birthday Day Off
Transportation allowance