Note: The job is a remote job and is open to candidates in USA. Humana is a leading Department of Defense contractor focused on the TRICARE healthcare program for military personnel. The TRICARE Community Liaison is responsible for building relationships with TRICARE customers and ensuring their understanding of the health plan, while also supporting network operations and customer satisfaction.
Responsibilities
- Provide accurate explanation of TRICARE health plan policies and procedures during on-site and electronic beneficiary, provider, and Government outreach activities, ensuring compliance with all customer support performance standards for the dual purposes of maximizing TRICARE customer satisfaction and the incentives paid by the Government, and of sustaining Humana Military’s competitive advantage for future contracts
- Respond in precise, comprehensive and timely manner to beneficiary, provider, and Government inquiries regarding eligibility, enrollment, billing, claims, referrals/authorizations, network operations, access to care, Defense Health Agency/TRICARE Health Plan policy, and other TRICARE topics. Implement, track and complete self-managed tasks to process and correct uncomplicated general eligibility, enrollment, billing, claims, referral/ authorization, and network difficulties experienced by TRICARE customers
- Research and resolve difficult, complex TRICARE problems/issues elevated by a Government agent, beneficiary, or provider within required timelines. Implement self-directed activities to analyze, coordinate, process, and complete action to correct multifaceted problems relating to eligibility, enrollment, billing, claims, referrals/authorizations, network operations, access to care, Defense Health Agency/TRICARE Health Plan policy, and other TRICARE topics
- Assist in developing and sustaining a high-performing network in designated PSAs/NSPAs which meets TRICARE and Humana Government Business requirements and optimization strategies. Contribute in achieving the network discount goal that results in annual financial incentives awarded by the Government. Conduct regular and ad hoc market laydown assessments to determine the capability and capacity of TRICARE providers, identifying and implementing action to address any gaps in the network. Participate in value-based care pilots through effective communication, consultation and support of selected providers
- Accomplish all administrative tasks as assigned, including documenting interactions, processing transactions, and submitting required reports
- Respond to and assist in contingency operations in support of the MTF and network as needed. Conduct urgent market laydown assessments to determine the capability and capacity of TRICARE providers, identifying and implementing action to accommodate changes in MTF services
- Participate in activities that promote well-being and professional growth of self and others
Skills
- Our Department of Defense contract requires U.S. Citizenship
- Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
- HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico
- Must live within 60 mile radius of West Point, New York, as it will be required to work on site several days a month
- Willingness to travel and work uncommon hours (nights/weekends) - involves some travel around New York area to provide briefings when needed
- One or two years' experience in customer relations, public contact position, and/or TRICARE, including presentations to groups
- Experience in handling high volume customer contacts in a courteous and professional manner
- Exceptional public-speaking ability
- Comprehensive knowledge of Microsoft Office Suite
- Experience in analyzing information, researching problems, and determining and implementing solutions
- Experience in healthcare provider relations
- Knowledge of the TRICARE program
Benefits
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- Short-term and long-term disability
- Life insurance
Company Overview
Humana is a health insurance provider for individuals, families, and businesses. It was founded in 1964, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is http://www.humana.com.
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