Execute strategic health management projects for the client portfolio aimed at controlling medical plan costs and promoting a culture of health and prevention within companies;
Monitor hospitalization authorizations to track ongoing admissions and propose strategies for discharge and reduction of unnecessary hospital stays;
Participate in health committees for key clients to analyze major risks in the health insurance policy and monitor implemented health actions;
Conduct health studies, mapping major variances and their financial impacts to prioritize key risks and define action plans based on identified deviations;
Provide technical support (analysis of medical claim denials, coverage under the ROL, and facilitating medical transfers with the insurer) requested by our clients;
Discuss medical cases with the clients' medical teams.
Requirements
Required qualifications:
Degree in Nursing with active COREN registration;
Intermediate knowledge of Microsoft Office (particularly intermediate Excel and PowerPoint);
Experience in the health benefits market, medical auditing, brokerages, or health insurers/operators;
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