Medical Auditor

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

📋 Description

• Perform online eligibility assessments and approve medical procedures in line with the guidelines and policies of client health plans.

• Provide well-reasoned technical assessments for elective, urgent, and emergency procedure requests during business hours via a specialized information system.

• Examine requested procedures with a high level of accuracy, adhering to sound medical criteria and relevant regulations.

• Maintain the confidentiality and integrity of medical information and patient records, ensuring compliance with the company's and client health insurers’ LGPD requirements throughout the auditing process.

⛳️ Requirements

• Bachelor's degree in Medicine.

• Active and unrestricted registration with the appropriate professional medical board (CRM), backed by a certificate of good standing from the professional council.

• Completed postgraduate qualification in Medical Auditing, along with a minimum of two (2) years of verified professional experience in the field.

• Relevant and varied clinical experience in multiple medical specialties.

• Valid CNPJ (Brazilian corporate tax registration).

• Strong understanding of medical guidelines, clinical procedures, reimbursement tables (e.g., AMB), and TUSS terminology.

• Comprehensive knowledge of ANS regulations, preparation of technical opinions, and health plan operational policies.

• Exceptional analytical skills to thoroughly, impartially, and decisively evaluate medical information.

• Exemplary ethical standards and strict confidentiality when managing sensitive information.

• Excellent time management and prioritization skills in a fast-paced, high-demand environment.

• Strong professional dedication, discipline, and organizational skills to work remotely.

• Collaborative mindset with the ability to effectively engage with other healthcare professionals.

• Outstanding written and verbal communication abilities.

• Basic computer proficiency and adaptability to new management systems.

🏝️ Benefits

• Remote work

• Contractor engagement under a PJ arrangement

• Business-hours schedule

• Affirmative opportunity for LGBTQIA+ individuals

• Affirmative opportunity for Black individuals

• Affirmative opportunity for Indigenous individuals

• Affirmative opportunity for individuals aged 40 and over

• Affirmative opportunity for women