FWA Negotiation Specialist

1 week ago

King of Prussia, United States Worldwide Insurance Services Full time
Job DescriptionJob Description

We are hiring for Fraud, Waste, & Abuse Negotiation Specialists to join the team A Fraud, Waste, & Abuse (FWA) Negotiation Specialist is responsible for the day-to-day execution of our enhanced claim control strategies. The specialist is on the front line of GeoBlue's effort to reduce unnecessary medical spending and make healthcare more affordable for everyone. The primary responsibility will be to evaluate claim submissions for evidence of fraud, waste, or abuse using an ever-increasing set of tools and techniques, none more important than good judgement and creative problem solving.

Responsibilities:

  • Determine if claim costs are Usual, Customary, and Reasonable through comparative analysis with historic claims.
  • Negotiate high-cost international claims with non-contracted providers and facilities.
  • Cultivate relationships with high volume providers and facilities.
  • Collaborate with the Provider Relations department to identify network expansion opportunities and evaluate fee schedule proposals.
  • Coordinate activities across other departments (ex. Clinical, Provider Finance, Global Service Center, Claims) and external entities (ex. home plans).
  • Perform online research to fill in gaps in existing tools and understanding.
  • Track activity and produce reports to measure impact and document actions.

Additional Responsibilities May Include:

  • Evaluate claims and determine the most applicable and appropriate remedy for preventing fraud, waste, or abuse.
  • Contact external third parties through outbound call or email to obtain additional information or verify claim information.
  • Validate accuracy of claim charges and initial processing decisions.
  • Attempt to obtain written confirmation of falsified claims through independent investigation and recorded interviews/interrogations.
  • Perform analysis on historic claims to determine the full scope of identified fraudulent activity.
  • Other duties as assigned.

Requirements:

  • College degree or equivalent experience required.
  • Minimum 3 years of insurance industry or other relevant experience required; 5-10 preferred.
  • Prior experience identifying or investigating fraud, waste, and abuse is not required, but is highly valued.
  • Strong working knowledge of international health insurance claims is a plus.
  • Knowledge of US domestic health insurance claims is a plus.
  • Strong attention to detail and problem-solving skills.
  • Excellent written and verbal communication skills.
  • Demonstrated ability to build relationships and negotiate positive outcomes.
  • Strong organizational skills, with the ability to manage multiple competing tasks at the same time.
  • Ability to manage ambiguity and drive for resolution.
  • Willingness and ability to learn and apply new skills.
  • Multilingual strongly preferred.
  • Employee is required to have at minimum an internet speed of 75 Mbps (standard high-speed internet access).

Working Conditions:

  • Flexibility to work in an office and/or at-home, remote office environment.
  • Schedule flexibility is occasionally necessary in this position. Individual may be required to attend key business/departmental meetings and/or perform certain business critical job functions outside of normal working hours.
  • Physical Demands: Must be able to communicate internally and externally through receiving and responding to auditory and visual methods.

Competitive base pay starting at $65,594 annually.

Compensation is based on prior/relevant experience and skill level in a similar role.


This job description reflects management’s assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.

  • Clinical Trial Specialist

    3 days ago

    King of Prussia, Pennsylvania, United States Beacon Hill Full time

    Job Summary:Beacon Hill Legal is seeking a skilled Clinical Trial Specialist to join our team in the greater Philadelphia region. This is a great opportunity for professionals with experience in clinical trial contracts in the life sciences industry.Key Responsibilities:Review, draft, and negotiate clinical trial agreements, consulting agreements, CDAs, and...

  • Clinical Trial Specialist

    4 days ago

    King of Prussia, Pennsylvania, United States Beacon Hill Full time

    Job SummaryBeacon Hill Legal is seeking a skilled Clinical Trial Specialist to join our team in the greater Philadelphia region. This is a great opportunity for professionals with experience in clinical trial contracts in the life sciences industry.Key ResponsibilitiesReview, draft, and negotiate clinical trial agreements, consulting agreements, CDAs, and...

  • Tax Collection Specialist

    3 days ago

    King of Prussia, Pennsylvania, United States Portnoff Law Associates, Ltd. Full time

    About Portnoff Law Associates, Ltd.Portnoff Law Associates, Ltd. is a reputable law firm specializing in the collection of unpaid real estate taxes and municipal utility fees. With over 200 municipal clients across Pennsylvania, our firm has established a strong presence in the industry.Job SummaryWe are seeking a highly motivated and detail-oriented Tax...

  • Clinical Trial Specialist

    4 days ago

    King of Prussia, United States Beacon Hill Full time

    Beacon Hill Legal is seeking clinical trial contracts specialists for an opportunity with a global biotechnology company in the greater Philadelphia region. This is a great, long-term temporary position for professionals with clinical trial contracts experience in the life sciences industry. Candidates selected for this position will be responsible for...

  • Payment Specialist

    3 months ago

    King of Prussia, United States The J.G. Wentworth Company Full time

    Job DescriptionJob DescriptionPayment SpecialistLocation- Chesterbrook, PA – Hybrid schedule***Only local candidates will be considered This Payment Specialist position offers a fast-paced, high energy office environment for those looking to make a positive impact on people’s lives. This is not a client facing position.  You will be doing the...

  • Individual Sales Support Specialist

    1 month ago

    King of Prussia, United States Worldwide Insurance Services Full time

    Job DescriptionJob DescriptionWe are seeking a Sales Support Specialist to join our Individual Sales team! The Individual Sales Support Specialist is an entry-level position and will help support our Individual Sales team. The overall goal is to assist in increasing the profitability of GeoBlue by supporting the Sales Directors, Managers, and a large Broker...

  • Project Coordinator

    3 days ago

    King of Prussia, Pennsylvania, United States Colonial Electric Supply Full time

    Job DescriptionJob Summary:We are seeking a highly skilled Project Coordinator - Switchgear Specialist to join our team at Colonial Electric Supply. As a leader of the gear project team, this person will be responsible for ensuring the project's success for both the client and Colonial. The ideal candidate will have excellent communication and...

  • Payment Specialist

    1 month ago

    King of Prussia, United States JG Wentworth Full time

    Payment SpecialistLocation- Chesterbrook, PA – Hybrid scheduleAs a Payments Specialist, you will support clients on an ongoing basis by reviewing update requests to payments schedules and enrolled debts, ensuring payments are made accurately and on time to creditors for active settlements and working with creditors to resolve escalations or exception...

  • Payment Specialist

    1 month ago

    King of Prussia, United States JG Wentworth Full time

    Payment SpecialistLocation- Chesterbrook, PA – Hybrid scheduleAs a Payments Specialist, you will support clients on an ongoing basis by reviewing update requests to payments schedules and enrolled debts, ensuring payments are made accurately and on time to creditors for active settlements and working with creditors to resolve escalations or exception...

  • Purchasing Specialist

    3 days ago

    King of Prussia, Pennsylvania, United States LMK Recruiting Full time

    Job OverviewLMK Recruiting is seeking a highly skilled Purchasing Associate to join our team. As a key player in our procurement process, you will be responsible for sourcing and purchasing cutting-edge cellular devices.Key ResponsibilitiesProcurement Management: Lead the procurement process from sourcing to negotiating and purchasing.Market Research:...

  • Enterprise Contracting Specialist

    5 days ago

    King of Prussia, Pennsylvania, United States CSL Behring Full time

    Job SummaryWe are seeking a highly skilled Contract Manager to join our Enterprise Contracting Center team at CSL Behring. As a key member of our team, you will be responsible for providing expert contract management services to support our business partners.Key ResponsibilitiesDevelop and maintain strong relationships with business partners to ensure...

  • Sales Development Specialist

    7 days ago

    King of Prussia, Pennsylvania, United States ACL Digital Full time

    We are looking for a dedicated Business Development Associate who possesses the ambition and skill set to enhance our client outreach. This role reports directly to the Director of Sales and Marketing. As the primary business development representative, your duties will encompass orchestrating strategies and nurturing relationships to propel our business...

  • Sales Development Specialist

    7 days ago

    King of Prussia, Pennsylvania, United States ACL Digital Full time

    We are looking for a talented Business Development Associate who possesses the ambition and skills necessary to enhance our client portfolio. This role will report directly to the Director of Sales and Marketing. As the lead for business development, your responsibilities will encompass strategizing and fostering relationships to propel our business model...

  • Collections Administration Specialist

    1 week ago

    King of Prussia, Pennsylvania, United States Portnoff Full time

    About Portnoff Law Associates, Ltd.Portnoff Law Associates, Ltd. is a distinguished legal firm that focuses on the recovery of outstanding real estate taxes and municipal utility fees. Renowned for its commitment to client satisfaction, the firm operates primarily within Pennsylvania.Position: Legal AdministratorOverviewWe are in search of a Legal...

  • Sales Development Specialist

    7 days ago

    King of Prussia, Pennsylvania, United States ACL Digital Full time

    We are looking for a dedicated Business Development Associate who possesses the ambition and skills necessary to help us grow our clientele. This role reports directly to the Director of Sales and Marketing. As the primary business development representative, your duties will encompass strategizing and nurturing relationships to enhance our business model....

  • Sales Development Specialist

    7 days ago

    King of Prussia, Pennsylvania, United States ACL Digital Full time

    ACL Digital is looking for a dedicated Business Development Associate who possesses the ambition and commitment to enhance our clientele. This role reports directly to the Director of Sales and Marketing. As the primary business development representative, the responsibilities encompass strategizing and nurturing relationships to propel our business model...

  • Credit Collections Specialist | Growing Company | Hybrid Work Schedule

    5 days ago

    King of Prussia, United States Power Pay Full time

    Job DescriptionJob DescriptionOur team is GROWING!!! We have a fabulous new opportunity to join the PowerPay team!PowerPay, a fast-growing financial technology company, is seeking a Collections/Credit Specialist to assist our growing team. We’re looking for a motivated individual who is willing to jump into the organization and start contributing. We are...

  • Contract Manager, Enterprise Contracting Specialist

    6 days ago

    King of Prussia, Pennsylvania, United States CSL Behring Full time

    About the RoleWe are seeking a highly skilled Contract Manager to join our Enterprise Contracting Center team at CSL Behring. As a Contract Manager, you will play a critical role in supporting the company's contracting needs, working closely with internal stakeholders and external partners to ensure seamless contract management.Key ResponsibilitiesProvide...

  • Board Certified Behavior Analyst

    3 months ago

    King of Prussia, United States Connecting the Pieces LLC Remote Work Freelance Full time

    Position titleBoard Certified Behavior Analyst (BCBA)/ Licensed Behavior Specialist (LBS) ( F2F and Remote) (F2F and Remote) - Chester County, PADescription Job description Connecting the Pieces is seeking  a Board Certified Behavior Analyst (BCBA) / Licensed Behavior Specialist (LBS)  to complete evaluations and provide services both virtually and...

  • Senior Human Resources Specialist

    2 weeks ago

    King of Prussia, Pennsylvania, United States Supplyforce Full time

    Job OverviewThe HR Operations Manager plays a crucial role in overseeing, coordinating, and managing all human resource functions within the organization. This position is essential for aligning HR activities with business goals and ensuring compliance with relevant regulations.Key Responsibilities:Identifies and ensures adherence to legal requirements and...