This is a fully remote position, open to applicants in Brazil.

📋 Description

• Receive and log notifications of claims

• Examine enrollment, medical, and legal documentation

• Evaluate coverage, policy validity, waiting periods, and eligibility of the insured

• Analyze medical reports, certificates, and other supporting claim evidence

• Detect potential fraud and refer cases for further investigation when necessary

• Draft technical opinions to either approve or deny coverage

• Authorize or recommend indemnity payments within the relevant approval limits

• Offer assistance and clarification to beneficiaries, brokers, and internal teams

• Ensure adherence to SLAs, regulatory standards, and internal policies

• Track productivity, quality, and turnaround-time metrics

• Engage in continuous improvement, automation, and process evaluation initiatives

⛳️ Requirements

• Bachelor’s degree in Business Administration or a related discipline

• In-depth knowledge of individual and group life insurance

• Understanding of basic and additional coverage types, including natural death, accidental death, IPA (Permanent Total Disability due to Accident), IFPD (Permanent Total Disability due to Illness), DIH (Daily Hospital Income), and critical illnesses

• Familiarity with policy terms and conditions as well as contractual clauses

• Basic understanding of reinsurance

• Knowledge of beneficiary analysis and succession order