Claims Specialist

• Analyze less complex medical claims, hospital claims, disputes, and appeals of claim denials submitted by healthcare providers and the Unimed System
• Analyze and release pre-analysis workflows in the management system
• Enter service data and arrange billing and rebilling
• Receive, organize in spreadsheets, and archive invoices
• Generate analytical reports and release processes to the Finance department
• Verify compliance with ANS regulatory requirements, the National Interchange Manual, and contractual rules
• Check amounts against reference tables and make the necessary adjustments
• Monitor billing deadlines and manage late billings
• Record decisions with appropriate justifications and validate signatures from other departments
• Provide support to healthcare providers and contracted providers regarding claims and appeals
• Request corrections to invoices and CMB and XML Portal files containing inconsistencies
• Propose improvements to operational workflows and stay up to date on internal standards and processes

Junior Medical Claims Analyst

• Oversee the parts supply process for motorcycles involved in claims
• Obtain quotes and conduct operational negotiations with motorcycle parts suppliers
• Monitor delivery deadlines and address deviations
• Track operational metrics, including average handling time (AHT), parts delivery SLA, and average claim cost
• Analyze motorcycle repair estimates and support technical claims assessment
• Liaise with the claims assessment, customer service, and logistics teams
• Contribute process improvement suggestions for the department
• Support audits and quality controls across the approved repair shop network
• Manage, develop, and optimize the network of accredited service providers
• Negotiate contracts, rate tables, and labor costs
• Analyze the performance of affiliated and non-affiliated repair shop networks
• Expand and qualify the network in strategic regions
• Monitor key performance indicators (KPIs)
• Resolve conflicts and provide technical support to the claims and customer service teams
• Conduct audits and technical site visits
• Implement process improvements and standardization

Claims Specialist jobs in Brazil

Junior Medical Claims Analyst

Senior Claims Analyst – Repair Shop Network and Parts Supply