Act as the technical reference for assisting beneficiaries of health, dental, life insurance and other corporate benefits, ensuring quality, problem resolution and a human-centered experience;
Manage complex cases with insurers and providers (provider network, authorizations, surgeries, tests and treatments), ensuring proper routing and resolution of requests;
Analyze and optimize service and benefits utilization workflows, propose process improvements and guide the team on best practices;
Serve as a strategic liaison with insurers and service providers, monitoring critical requests, negotiations and care-related interactions;
Evaluate reimbursement requests, ensuring compliance with benefit policies and providing technical support to resolve inconsistencies;
Advise beneficiaries on proper use of plans and available tools, promoting greater engagement and an improved benefits experience;
Arrange appointments, tests and executive check-ups for priority or complex situations;
Monitor authorizations for procedures, tests and surgeries, ensuring documentation compliance and case follow-up;
Participate in in-person activities of the Amar & Cuidar program when required, providing specialized support and contributing to the beneficiary experience;
Monitor service and benefits utilization indicators, contributing to analyses and recommendations to improve program management.

Bachelor's degree in Social Work, Psychology or Human Resources Management
Prior experience in customer service (healthcare or insurance)
Strong communication, organizational skills, agility and willingness to follow defined workflows
Availability to work in a hybrid model (2 days on-site per week) during the hours of 9:00 AM to 6:00 PM.

Benefits Specialist

Key skills