Forensic & Audit Agent

About the role

The Forensic & Audit Agent supports the detection, investigation and prevention of fraud, abuse, waste and irregularities in health benefit usage. The role combines data analysis, claims auditing and case management to reduce losses and strengthen internal controls.

Key responsibilities

• Analyze alerts from fraud detection systems and cross‑reference them with claims histories, pre‑authorizations and member/provider data to identify suspicious cases.
• Conduct claims audits reviewing invoices, prescriptions, clinical reports and billing codes to spot duplicate billing, services not provided or excessive quantities.
• Register, monitor and document investigation cases, ensuring evidence integrity, confidentiality and traceability.
• Prepare research reports, calculate undue amounts, support recoveries and propose improvements to detection rules and internal processes.

Required profile

• 1–2 years of experience in a corporate environment, preferably in healthcare or insurance.
• Completed 12th grade with a diploma in Health, Nursing, Pharmacy, Biomedical Sciences or related field.
• Good oral and written communication in Portuguese and basic English.

Required skills

• Advanced proficiency in Microsoft Excel.
• Experience with office productivity tools and data‑analysis or case‑management systems.

What we offer

• A collaborative work environment with opportunities for professional growth.
• 100% subsidized medical aid.