Richard Tishman

• Handles Member calls & cases for claims fee negotiation Negotiates Consumer/Member Medical Claims with Healthcare Providers Send and Acknowledge receipt of Contracts from Consumers/Members and Provider
• Tracks all Settlements
• Reports Settlement results within the system and Statistics to Management
• Works with other Health Advocate units, including training when needed
• Works with product development VP to refine process and improve the Consumer/Member Settlement product
• Supports Sales & Marketing as SME, including participation in meetings with Current and Prospective Customers
• Provides benefit and claims consultation and support when appropriate to all internal departments.

• Supervised 60 person call center and 15 person claims team.

• Examined process, calculate and adjudicate claims in compliance with plan documentation in an AS 400 environment.

• Monthly one on one to review performance and stats.

• Ensured regular and effective communication with staff on performance, goals, and coaching.

• Advised recommendations to implement improved processes.

• Provided service to claimants, providers, and clients with problems or questions regarding their claims and/or policies via telephone or correspondence.

• Provided daily support to claim staff on claim managing

• Assisted claim personnel in coverage investigation, liability analysis and settlement negotiation.

• Evaluated professional skills of claim staff and provided appropriate claim assignments

• Hired and trained new candidates

• Met metrics goal of 50 faxes processed and 80 provider calls per day. • Took provider calls, built inpatient/outpatient cases, and answered provider questions.

• Acted as a liaison between the providers and the medical director. • Processed incoming DME, Prior Authorization, inpatient stay, and Concurrent Review Faxes/Claims.

• Identified problems including complex issues and determine solutions, both independently or in a team/ group setting.

• Top Secret Clearance.

• Conducted counterintelligence operations and processed intelligence evidence.

• Protected sensitive technologies.

• Prepared and distributed reports.

• Conducted source operations.

• Debriefed personnel for counterintelligence collections, and supporting counter-terrorism operations.

• Detect, exploit and neutralize intelligence threats.

• Preformed Background investigations for security clearances.