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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing authorization requests, including assessment and validation processes, while ensuring compliance with regulations from ANS. Proficient in utilizing the TOTVS system and Excel to track and manage health plan authorizations effectively.
Highest-signal resume keywords
Authorization ManagementTOTVS System ProficiencyRegulatory Knowledge (ANS)Excel ProficiencyCustomer Service Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Authorization ManagementTOTVS System ProficiencyExcel ProficiencyHealth Plan Coverage VerificationAdministrative Validation
Soft Skills
Customer Service SkillsProblem-SolvingCommunication Skills
Tools & Technologies
Health Plan Management SystemUnimed Portal
Industry Keywords
ANS RegulationsMedical AuditingAuthorization RequestsCooperative Processes
About the role
Key responsibilities & impact- Review authorization requests received through the Unimed portal, website, in-person service, call center, and other channels.
- Track deadlines and targets for authorization requests.
- Stay up to date on the cooperative’s processes.
- Conduct the preliminary assessment and administrative validation of requests, identifying denials, waiting periods, medical reports, and documents in the TOTVS system.
- Verify health plan coverage and approve or deny authorizations within the required timeframe using the TOTVS system.
- Enter authorizations into the health plan management system.
- Contact beneficiaries, cooperative members, and providers by phone, providing information about denials, authorizations, medical review boards, and document requests.
- Report the need for corrections to system parameterization.
- Handle authorization requests from customers, providers, and other Unimeds.
- Seek alternatives to resolve questions and meet the needs of customers, providers, and the cooperative.
- Resolve questions with the provider network and other contracting companies, providing support to other departments.
- Contribute to projects aligned with the company’s and department’s strategy.
- Support and resolve operational demands that may hinder the smooth flow of audit processes.
- Monitor and schedule meetings for the Department Manager related to Medical Auditing.
- Handle prioritization and demands related to authorizations or denials of medical procedures and examinations reviewed by Medical Auditing.
Requirements
What you’ll need- High school diploma.
- Intermediate proficiency in Excel.
- Knowledge of current regulations issued by ANS (Brazil’s National Supplementary Health Agency).
- Degree in progress or completed in Business Administration, Processes, or a related field. (Preferred qualification)
- Postgraduate degree in progress or completed. (Preferred qualification)
Benefits
Comp & perks- Hybrid work environment
- Future opportunities through the talent pool
- Support for professional development
- Participation in projects aligned with the company’s strategy
- Position also open to people with disabilities (PwD)