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Medical Audit Specialist
Unimed Federação MinasMédico especialista apoiando a Unimed Federação Minas em auditoria médica, regulação e decisões sobre saúde suplementar. Elaborando pareceres técnicos, analisando procedimentos e coordenando juntas médicas em Belo Horizonte.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medical Auditing, providing technical advice on ANS regulations and health-related legislation while conducting thorough analyses of medical documentation and procedures. Capable of leading training sessions and representing organizations in technical forums to enhance health auditing practices.
Highest-signal resume keywords
Medical Degree (MD)Experience In Medical AuditingKnowledge Of ANS RegulationsPostgraduate Specialization In Health AuditingFamiliarity With Auditing Systems And Tools
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Medical AuditingTechnical Opinion ProductionEvidence-Based Medicine AnalysisRegulatory Compliance EvaluationHigh-Cost Procedure Analysis
Soft Skills
LeadershipCommunicationTraining Coordination
Certifications & Qualifications
Postgraduate Specialization In Health Auditing
Industry Keywords
ANS RegulationsHealth LegislationMedical Audit RulesSupplementary Health RegulationsMedical Management
About the role
Key responsibilities & impact- Act as the technical reference in Medical Auditing for auditors of the Federation and Unimeds of Minas Gerais
- Provide technical advice on ANS regulations, health-related legislation and medical audit rules
- Review medical documentation and requests, producing technical opinions on low-, medium- and high-complexity procedures
- Conduct analyses based on scientific literature, evidence-based medicine and supplementary health regulations
- Audit requests and claims related to the Regulation Center
- Prepare technical opinions for arbitration panels, litigation, dispute of billing denials and other regulatory demands
- Participate in the medical management of the Partial Coverage Fund for Medical Accounts, including analysis of high-cost procedures
- Manage Medical/Dental Board processes, monitoring deadlines, gathering additional information, selecting tie-breaker professionals and issuing opinions
- Lead alignment meetings related to Medical Boards with the Unimeds
- Evaluate the incorporation of new health technologies, conducting studies and analyses to support decision-making
- Organize, coordinate and deliver training sessions and seminars for Unimed auditors
- Provide on-site consultancy related to auditing and exchange services
- Represent Federação Minas in groups, technical chambers and specialized forums, promoting knowledge exchange and strengthening health auditing practices
Requirements
What you’ll need- Medical degree (MD)
- Experience in medical auditing
- Knowledge of or interest in auditing, regulation and supplementary health
- Postgraduate specialization in Health Auditing or related area is a plus
- Familiarity with systems and tools used in auditing and regulation workflows is a plus
Benefits
Comp & perks- Profit-sharing (results participation)
- Unimed medical coverage
- Unimed dental coverage
- Private pension plan
- Life insurance
- Meal voucher or food allowance (no employee contribution)
- Transport voucher or fuel allowance (no employee contribution)
- Happy Day
- Wellhub
- In-person and online training for professional development
- Workplace health program offering psychological, financial and legal guidance
- And others