FWA Negotiation Specialist

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.
• Cookordinate 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.

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.
• Able to manage ambiguity and drive for resolution.
• Willingness and ability to learn and apply new skills.
• Multilingual strongly preferred.