Meghan Simmons Email & Phone Number

Jacksonville, Florida

• Identify, develop, recommend, and implement process, procedure, and program improvement.• Serve as leader and subject matter expert on various organization wide projects.• Effectively identify, develop and coordinate communications to educate internal and external customers through continuous training, relationship management, and enhancement of processes to ensure quality, cost management, and customer satisfaction, utilizing procedures, training materials, verbal communication, and reports.• Responsible for ensuring claims and appeals processing issues are addressed timely and changes are implemented effectively.• System maintenance and testing.

Jacksonville, Florida Area

• Research and review denial inquires received from providers and beneficiaries.• Utilize various systems e.g. FISS, HIMR, EDOC, MAS, HIGLAS, to determine the most efficient method for completing the appeals in a timely and accurate manner• Compose, review, and proofread correspondence for accuracy and completeness.• Effectuate claims during the reopening process or after medical review• Complete special projects as assigned

Albany, New York Area

• Respond to provider’s questions via telephone and written correspondence regarding insurance benefits, provider contracts, patient’s eligibility, and claims.• Analyze problems and provide solutions based on documented information and make changes accordingly in the database.• Utilize various systems for tracking, information gathering, troubleshooting, research, and analyze data to address operational challenges and customer service issues.

Norfolk, Virginia Area

Customer Service Representative• Consult with customers regarding the repair of their vehicles per the estimate written by the customers Auto Insurance company. • Serve as the main point of contact between the customer and the body shop technicians to include estimating the cost of additional repairs not addressed in the original estimate.• Ensure the customer is fully satisfied with the quality of the repairs.

Norfolk, Virginia Area

• Review and analyze provider information and status through database inquires.• Obtain, process, manage, and maintain both hard-copy and computer based provider information necessary for network development and maintenance activities.• Assist in day to day department activities including phone coverage and file maintenance. • Preform research and problem resolution on issues related to provider complaints, claims reported to have been processed incorrectly, • Maintain daily logs for future reference and analysis as well as document inquiries and complaints appropriately in applicable databases• Service calls in a professional and courteous manner. Address concerns of dissatisfied and/or angry providers in a diplomatic manner.