Medical Auditor

Unimed do Brasil

Médico Auditor responsável pela análise de contas médicas no Sistema Unimed. Avaliação de solicitações e auditoria técnica de contas hospitalares e ambulatoriais.

Posted 7/7/2026full-timeSão Paulo • 🇧🇷 BrazilMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Evaluate requests for procedures, exams, hospitalizations and treatments for clinical indication and scientific evidence
Issue technical opinions regarding authorizations, denials or requests for additional information
Interact with medical auditors from Unimed organizations
Assess care packages, evaluating the appropriateness of orthoses, prostheses and special materials (OPME)
Ensure compliance with ANS regulations, current legislation and internal policies
Perform technical audits of hospital, outpatient and high-complexity procedure accounts
Prepare well-founded technical reports for claim denials and denial appeals
Ensure timely responses in accordance with current regulations
Identify and report deviations in care quality and opportunities for improvement
Participate in claims analysis and develop action plans together with Unimed local organizations
Contribute to medical audit quality and performance indicators

Requirements

What you’ll need

Medical degree (completed)
Active registration with the Regional Medical Council (CRM)
Experience in Health Audit
Knowledge of current legislation applicable to Supplementary Health
Knowledge of ANS standards and the Procedures List (Rol de Procedimentos)
Knowledge of materials and medications tables
Familiarity with TUSS/ANS, CBHPM, AMB, Unimed Medical Procedures List, TNUMM and LPM tables
Professional experience within the Unimed System
Knowledge of Unimed System rules, with focus on National Interchange
Postgraduate qualification in Health Audit is a plus

Benefits

Comp & perks

Health insurance
Dental plan
Pharmacy discount program
Gym membership discounts
Influenza vaccination campaign
Fruit day
Baby welcome kit
Internal marketing / employee engagement initiatives
Additional day off during birthday month
Gift card
Psychological support program
Rest and relaxation area
Food allowance (vale-alimentação)
Meal voucher (vale-refeição)
Flexible working hours
Transport voucher or parking
Payroll-deductible loans
Partnership with a bank
Supplier partnership for infant nutrition support
Private pension plan
Life insurance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Clinical EvaluationTechnical AuditsClaims AnalysisTechnical Report PreparationCompliance Assessment

Soft Skills

Interpersonal CommunicationAnalytical ThinkingProblem-Solving

Certifications

Postgraduate Qualification in Health Audit