{"id":33533,"date":"2026-10-15T20:47:22","date_gmt":"2026-10-15T20:47:22","guid":{"rendered":"https:\/\/wizandroidmz.com\/emprego\/?p=33533"},"modified":"2026-10-15T20:47:22","modified_gmt":"2026-10-15T20:47:22","slug":"vaga-forensic-audit-agent","status":"publish","type":"post","link":"https:\/\/wizandroidmz.com\/emprego\/vaga-forensic-audit-agent\/","title":{"rendered":"Vaga &#8211; Forensic &#038; Audit Agent"},"content":{"rendered":"<p><strong>1. OVERALL RESPONSIBILITY <\/strong><\/p>\n<p>Support the detection, investigation and prevention of fraud, abuse, waste and irregularities in the use of health benefits, through data analysis, claims auditing and case document management. Contribute to the reduction of losses and improvement of internal controls.<\/p>\n<p><strong>2. PRIMARY DUTIES <\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>a)\u00a0\u00a0\u00a0\u00a0Data discovery and analysis:<\/strong><\/p>\n<ul class=\"hv4kr0 hv4k0t hv4lg2\">\n<li>Analyze alerts from fraud detection systems, including biometric device transactions and claims processing data.<\/li>\n<li>Cross-reference alerts with claims histories, pre-authorizations, and member and provider data to identify cases that require investigation.<\/li>\n<li>Identify suspicious patterns, duplications, excessive frequencies, and outliers.<\/li>\n<\/ul>\n<p><strong>b)\u00a0\u00a0\u00a0\u00a0Claims audit:<\/strong><\/p>\n<ul class=\"hv4kr0 hv4k0t hv4lg2\">\n<li>Review invoices, prescriptions, clinical reports, diagnoses, procedures, codes and tariffs.<\/li>\n<li>Identify services not provided, duplicate or advance billing, excessive quantities, undue prices and services already included in packages.<\/li>\n<li>Support desk audits and visits to providers to verify billed services and compliance with applicable rules.<\/li>\n<\/ul>\n<p><strong>c)\u00a0\u00a0\u00a0\u00a0Investigation and case management:<\/strong><\/p>\n<ul class=\"hv4kr0 hv4k0t hv4lg2\">\n<li>Register and monitor cases on the investigation management platform, keeping facts, actors, evidence and decisions duly documented.<\/li>\n<li>Support investigations involving members, contractors, intermediaries, collaborators and possible situations of collusion.<\/li>\n<li>Prepare requests for clarification, analyze responses and refer complex cases to the Senior Manager.<\/li>\n<li>Ensure the integrity, traceability and confidentiality of evidence.<\/li>\n<\/ul>\n<p><strong>d)\u00a0\u00a0\u00a0\u00a0Reporting and prevention:<\/strong><\/p>\n<ul class=\"hv4kr0 hv4k0t hv4lg2\">\n<li>\u00a0Prepare research reports with results, evidence, values involved and recommendations.<\/li>\n<li>\u00a0Support the calculation of undue amounts, recoveries and avoided losses, as well as the preparation of periodic indicators.<\/li>\n<li>Identify control failures and propose improvements in detection rules and internal processes.<\/li>\n<li>\u00a0Monitor the approved corrective measures, in conjunction with the areas responsible.<\/li>\n<\/ul>\n<p><strong>e)\u00a0\u00a0\u00a0\u00a0Collaboration and compliance:<\/strong><\/p>\n<ul class=\"hv4kr0 hv4k0t hv4lg2\">\n<li>Collaborate with the Clinical, Claims, Pre-Authorizations, Provider Management, Finance and Information Technology areas.<\/li>\n<li>Comply with internal policies, legal requirements and data protection and confidentiality rules.<\/li>\n<li>Perform other forensic audit-related tasks assigned by the Senior Manager.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong> 3.\u00a0\u00a0\u00a0\u00a0JOB REQUIREMENTS:<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong> 3.1.\u00a0\u00a0Experience &amp; Qualification:<\/strong><\/p>\n<p>&nbsp;<\/p>\n<ul class=\"hv4kr0 hv4k0t hv4lg2\">\n<li>At least 1\u20132 years of experience in a corporate environment, experience in the healthcare or insurance sector is an advantage.<\/li>\n<li>12<sup>th<\/sup> grade completed, diploma in Health, Nursing, Pharmacy, Biomedical Sciences or a related area is preferred.<\/li>\n<li>Knowledge of clinical terminology, diagnostic codes and procedures, tariffs and billing of health services.<\/li>\n<li>Knowledge of auditing, investigating or preventing fraud is an advantage.<\/li>\n<li>\u00a0Mastery of office tools, especially Excel, and ease of use of data analysis and case management systems.<\/li>\n<li>Good oral and written communication in Portuguese and knowledge of English.<\/li>\n<\/ul>\n<p><strong>3.2.\u00a0Skills &amp; attributes:<\/strong><\/p>\n<p>&nbsp;<\/p>\n<ul class=\"hv4kr0 hv4k0t hv4lg2\">\n<li>Analytical skills.<\/li>\n<li>Attention to detail.<\/li>\n<li>Identification of patterns.<\/li>\n<li>Organization.<\/li>\n<li>Report preparation.<\/li>\n<li>\u00a0Case follow-up.<\/li>\n<li>Integrity.<\/li>\n<li>Impartiality.<\/li>\n<li>Discretion.<\/li>\n<li>\u00a0Accountability.<\/li>\n<li>Teamwork.<\/li>\n<\/ul>\n<p>What We Offer:<\/p>\n<ul class=\"hv4kr0 hv4k0t hv4lg2\">\n<li>A collaborative work environment.<\/li>\n<li>Opportunities for professional growth.<\/li>\n<li>100% Subsidized Medical Aid.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>\ud83d\udce9 To apply, send your resume <strong>cv@mediplusmz.com <\/strong>with the subject line &#8221; <strong>your name &#8211; Forensic &amp; Audit Agent<\/strong>&#8221;<\/p>\n<p>&nbsp;<\/p>\n<p>\ud83d\udccc Only shortlisted candidates will be contacted.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>1. OVERALL RESPONSIBILITY Support the detection, investigation and prevention of fraud, abuse, waste and irregularities in the use of health benefits, through data analysis, claims auditing and case document management. Contribute to the reduction of losses and improvement of internal controls. 2. PRIMARY DUTIES \u00a0 a)\u00a0\u00a0\u00a0\u00a0Data discovery and analysis: Analyze alerts from fraud detection systems, [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":28235,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[36],"tags":[],"class_list":["post-33533","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-vaga"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/wizandroidmz.com\/emprego\/wp-content\/uploads\/2026\/02\/mediplusmz.png","_links":{"self":[{"href":"https:\/\/wizandroidmz.com\/emprego\/wp-json\/wp\/v2\/posts\/33533","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wizandroidmz.com\/emprego\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wizandroidmz.com\/emprego\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wizandroidmz.com\/emprego\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wizandroidmz.com\/emprego\/wp-json\/wp\/v2\/comments?post=33533"}],"version-history":[{"count":1,"href":"https:\/\/wizandroidmz.com\/emprego\/wp-json\/wp\/v2\/posts\/33533\/revisions"}],"predecessor-version":[{"id":33534,"href":"https:\/\/wizandroidmz.com\/emprego\/wp-json\/wp\/v2\/posts\/33533\/revisions\/33534"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/wizandroidmz.com\/emprego\/wp-json\/wp\/v2\/media\/28235"}],"wp:attachment":[{"href":"https:\/\/wizandroidmz.com\/emprego\/wp-json\/wp\/v2\/media?parent=33533"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wizandroidmz.com\/emprego\/wp-json\/wp\/v2\/categories?post=33533"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wizandroidmz.com\/emprego\/wp-json\/wp\/v2\/tags?post=33533"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}