About this role
Role Overview
- Support and resolve operational requests that impact the flow of audit processes;
- Handle priority requests and other inquiries from Unimed areas, especially regarding authorizations and denials of procedures and exams;
- Verify authorization requests received through available channels (Unimed Portal, website, in-person service, call center, among others);
- Monitor deadlines and targets related to authorization requests;
- Stay up to date on the cooperative’s internal processes, ensuring effective execution of activities;
- Perform pre-evaluation and validation of requests, analyzing administrative information such as claim denials, waiting periods, medical reports and attached documents, based on data registered in the TOTVS system to prevent improper authorizations;
- Verify beneficiaries’ health plan coverage and approve or deny authorizations within the deadline, according to the analysis in the TOTVS system;
- Record authorizations in the Plan Management system;
- Contact beneficiaries, cooperative members and providers by phone to communicate information about authorizations, denials, medical review board decisions or document requests;
- Identify and report the need for corrections in system parameterization to prevent authorization failures;
- Respond to authorization requests from clients, providers and other Unimeds;
- Seek alternatives to resolve doubts, ensuring satisfaction of the end customer, providers and the cooperative;
- Clarify questions with the provider network, contracting companies and provide support to other areas of the organization regarding authorizations.
Requirements
- High school diploma;
- Intermediate proficiency in Excel;
- Knowledge of current ANS (National Supplementary Health Agency) regulations;
- Higher education in progress or completed; postgraduate studies in progress or completed.