Fraud Waste & Abuse Specialist
Hybrid · King of Prussia, Pennsylvania, United States
Job Summary
Fraud, Waste and Abuse Specialist responsible for day-to-day execution of enhanced claim control strategies, evaluating claim submissions for evidence of fraud, waste or abuse, contacting external parties to verify information, supporting negotiations on high-cost claims with providers, validating claim charges, coordinating cross-departmental activities, and performing analyses to measure impact and document actions. Requires a Bachelor’s degree (or equivalent), 3+ years in insurance, strong attention to detail, knowledge of international health insurance claims, and multilingual communication skills. Hybrid work model in King of Prussia, PA with remote-abroad arrangements available.
Required Qualifications
- Bachelor’s degree or equivalent experience
- Minimum of 3 years insurance industry experience
- Strong attention to detail and problem-solving skills
- Strong working knowledge of international health insurance claims
- Knowledge of US domestic health insurance claims is a plus
- Excellent written and verbal communication skills
- Strong organizational skills
- Multilingual strongly preferred
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