Claims Denial Appeals Analyst, Mid-level

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🕒 July 8

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Unimed Nacional

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1998

⚕️ Healthcare Insurance

👥 B2C

🤝 Non-profit

Healthcare Insurance • B2C • Non-profit

Unimed Nacional is an organization that provides various healthcare services and benefits for its members, aiming to enhance access to medical care in Brazil. It operates within a network of healthcare professionals and facilities to offer comprehensive health solutions to individuals and families.

📋 Description

• Review daily billing return notices or denial (glosa) reports issued by the payer. • Set priorities for execution timing and appeal response deadlines, ensuring secure completion of the process and mitigating negative financial impacts. • Interface with support and customer service teams to validate denial entries. • Prepare substantiated justification reports to be sent to the payer. • Support internal teams by reporting weaknesses that led to denials so processes can be corrected. • Produce monthly reports and KPIs demonstrating denial trends and present implemented action plans. • Work collaboratively with involved departments, focusing on alignment and continuous improvement. • Resolve potential account discrepancies with other departments promptly, ensuring the appeal response complies with contractual agreements.

🎯 Requirements

• Education: Bachelor's degree. • Software and Tools: Proficiency with Excel spreadsheets. • Skills and Competencies: Detail-oriented, organized, strong communication skills, understanding of the revenue cycle, and appreciation for the importance of timeliness in meeting deadlines. • Business Knowledge: Must understand care workflows, service processes, and the complexity of varied contractual agreements. • Nice-to-have: Experience with operational systems in the billing module, charge schedules/billing tables, and denial appeals processes.

🏖️ Benefits

• Medical Insurance: Outpatient, hospital and obstetrics coverage for you and your legal dependents. • Dental Insurance: Company-subsidized plans covering basic procedures up to orthodontics and prosthetics. • Pharmacy Program: Access to discounted medications at participating pharmacies with payroll deduction and salary-based limits. • Wellhub (Gympass): Wellbeing platform providing access to gyms and health apps, extendable to up to three dependents. • Meal Card: Daily allowance credited for each working day to cover meals. • Food Card: Monthly credit to assist with grocery purchases. • Private Pension Plan: Company-established plan to help build financial reserves and future income. • Life Insurance: Coverage for death and disability, providing financial protection for you and your family. • Annual Performance Bonus (PPR): Annual reward based on meeting the cooperative's collective targets. • Transportation Allowance: Available for commuting between home and work for in-office or hybrid arrangements. • Parking: Agreements with parking facilities near company sites. • Birthday Day Off: One day off granted after your birthday for you to use as you wish. • Family Support: Childcare or nanny assistance for employees with children up to 16 months. • Benefits Club: Partnerships and discounts at educational institutions, language schools, and leisure providers.