Perform technical regulatory reviews;
Communicate in writing to the appropriate parties your observations, conclusions and recommendations after reviewing claim/authorization forms;
Issue technical opinions within your area of expertise;
Report to Medical Coordination any indications of ethical or legal misconduct identified;
Request reports from the audited party when necessary;
Act impartially when issuing technical reports and opinions;
Stay up to date with the latest medical practices, clinical guidelines and regulations related to health plans;
Ensure the confidentiality and integrity of medical information, complying with the company's and client operators' LGPD (Brazilian General Data Protection Law) requirements throughout the audit process.

Medical degree (completed);
Postgraduate specialization in Neurology;
Active and regular registration with the Regional Medical Council (CRM);
Experience in prospective auditing;
Specialty in Neurology or Neurosurgery;
Proficient in Microsoft Office (Office Suite);
Ethics declaration;
Experience working in multidisciplinary teams;
Experience at a health insurance operator;
Postgraduate specialization in auditing or related fields;
Familiarity with ANS (Brazilian National Supplementary Health Agency) regulations, technical opinions and health plan policies;
Technical reading proficiency in English.

Medical Auditor - Neurology

Key skills