Robert Starkey

Manage Kaiser Permanente grievance cases from intake through resolution, including member education, receipt acknowledgment, deadline tracking, and detailed documentation. Draft outcome letters and coordinate with internal departments and regulatory/government agencies including the Department of Managed Health Care.

Coordinate written consumer inquiries for appeals, grievance, and complaint processes by gathering dental records, contacting dentists, and working with insurers as needed. Perform intake quality assurance, maintain dental code knowledge, build Excel case trackers, and write detailed outcome letters for enrollees and dental facilities in coordination with regulatory agencies.

Handle member inquiries for appeals, grievances, and complaints, including inbound/outbound calls and health insurance support. Gather and route documents to clinical reviewers, maintain detailed records, educate members on plans, and issue outcome letters while applying ICD-9 and ICD-10 coding knowledge.

Answer 50–80 inbound calls per day while performing Tricare-related data entry and processing monthly, quarterly, and annual payments. Research health plan and eligibility status, process scanned/faxed documents, meet quality assurance goals, calculate final payments, and follow up outbound calls to ensure beneficiary satisfaction.

Support Tricare authorization and appointment workflows by scheduling appointments and extended referrals and entering data accurately to ensure veterans receive care. Work with ICD-9 codes, collaborate with the Veterans Administration, manage urgent emails and congressional cases, and maintain case records for supervisor turnover.

Provide customer support for Covered California by receiving inbound calls and assisting consumers in completing health insurance applications. Verify consumer information and documents, educate callers on plan options, maintain detailed notes, and manage inquiries related to appeals and complaints.