FWA Negotiation Specialist

1 week ago


King of Prussia, Pennsylvania, United States Worldwide Insurance Services Full time
Job Title: FWA Negotiation Specialist

We are seeking a highly skilled FWA Negotiation Specialist to join our team at Worldwide Insurance Services. As a key member of our team, you will play a critical role in reducing unnecessary medical spending and making healthcare more affordable for everyone.

Key Responsibilities:
  • Evaluate claim submissions for evidence of fraud, waste, or abuse using advanced tools and techniques.
  • Negotiate high-cost international claims with non-contracted providers and facilities.
  • Cultivate relationships with high-volume providers and facilities to ensure seamless claim processing.
  • Collaborate with cross-functional teams to identify network expansion opportunities and evaluate fee schedule proposals.
  • Perform online research to fill gaps in existing tools and understanding.
  • Track activity and produce reports to measure impact and document actions.
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.
Working Conditions:
  • Flexibility to work in an office and/or at-home, remote office environment.
  • Schedule flexibility is occasionally necessary in this position.
  • 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.



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