Tricare Community Liaison - Humana : Job Details

Become a part of our caring community and help us put health first

The TRICARE Community Liaison (TCL)- is a customer-facing Humana Military associate who is knowledgeable, professional, and courteous. This role interacts in person and by other means, such as by telephone, e-mail, and chat with TRICARE beneficiaries, Medical Treatment Facility (MTF) and other Government staff, including senior military leaders, and civilian healthcare providers and facilities. The primary focus of the TCL is to develop and sustain strong, collaborative relationships with all TRICARE customers in the East Region - Government, beneficiaries, and providers. The TCL must be cognizant of the military way of life during all interactions, including the impact of stress, trauma, and loss on active, reserve component and retired service members and their families that result from military operations. Assigned to specific Health System Areas comprised of Prime Service Areas (PSAs) and Non-Prime Service Areas (NPSAs) in a geography that may span over 43,000 square miles, the team's area of responsibility can include an average of more than 100,000 beneficiaries, 50,000-70,000 network and non-network providers, numerous National Guard/Reserve units, and two to three MTFs.

Through clear and concise communication, the TRICARE Community Liaison (TCL) is responsible for ensuring MTF, beneficiary, and provider understanding of the TRICARE health plan and how to navigate the Military Health System. The TCL also supports the Health System Operations Leader in local TRICARE network operations, including participating in network development and optimization strategies which focus on a medically ready force and a ready medical force. The TCL requires little supervision and uses independent, critical decision-making in managing time, setting priorities, addressing general inquiries, and resolving both straightforward inquiries and complicated problems and concerns raised by beneficiaries, providers, and Government customers. The TCL may be designated as an embedded associate at an MTF and may be requested to provide back-up coverage in the absence of the Health System Operations Leader. This position will require work during uncommon duty hours and travel to conduct outreach activities.

KEY ACCOUNTABILITIES

45% Provide accurate explanation of TRICARE health plan policies and procedures during on-site and electronic outreach activities, ensuring compliance with all customer support performance standards. Outreach activities will include interactions with beneficiaries in all categories, no matter the TRICARE plan, network and non-network providers, Military Health System staff, local Military and Veterans Support Organizations (MSOs/VSOs), and at venues related to military and family readiness

20% Respond in precise, comprehensive and timely manner to beneficiary, provider, and Government inquiries (whether received electronically, in hard copy or in person) regarding eligibility, enrollment, billing, claims, referrals/authorizations, appointment assistance, 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.

10% 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.

10% 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.

5% Accomplish all administrative tasks as assigned, including documenting interactions, processing transactions, and submitting required reports.

5% 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.

5% Participate in activities that promote well-being and professional growth of self and others.

• You will work remotely but this position will need to travel onsite a few days a week to Aberdeen Proving Ground, MD.

• Will also travel to and provide additional support for briefings to Glen Burnie, MD (Baltimore Coast Guard) and other locations through out Northern Virginia, Washington D.C. and Maryland.

This position description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department, and/or company objectives .

Use your skills to make an impact

Required Qualifications

• 2 or more years of experience in customer relations, public contact position, and/or TRICARE experience to include making presentations to groups

• Experience in handling high volume customer contacts in a courteous and professional manner

• Demonstrated ability to analyze information, research problems, and determine and implement solutions

• Ability to multi-task and work in a very fast-paced environment

• Strong written and verbal communication skills to include presentation skills

• Excellent interpersonal skills and ability to develop collaborative working relationships across multiple functional areas in the organization or with consumers

• Consultative skills which include ability to assess, understand the consumer, and make recommendations

• Experience in analyzing information, researching problems, and determining and implementing solutions

• Ability to interpret and understand policy and/or government contracts (I.E. TRICARE, Medicare, Medicaid, CMS etc....)

• Comprehensive knowledge of Microsoft Office Suite to include Word, Excel, OneNote, PowerPoint, and/or Access

• Willingness to travel and work uncommon hours - MUST be flexible and have reliable transportation

• Proven ability to deliver clear and concise information, adapt content to audience needs, and manage Q&A sessions with confidence for both small and large audiences of active-duty, retirees and families.

• Our Department of Defense Contract requires U.S. citizenship for this position

• Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS)

• 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 a 30-40-mile radius of the Aberdeen Proving Ground, MD market

Preferred Qualifications

• Experience with TRICARE contracts and/or the military health care delivery system

• Knowledge of TRICARE policies and benefits

• Prior experience in a medical office setting

• Experience with medical claims/health insurance

• Experience in Provider relations

• Bachelor's degree

Additional Information

Work Style : Hybrid (Remote/On-site)

Work Location(s) :

• Primary will be Remote/Work at Home, but this position will require a few days a week to travel/work onsite at the Military Treatment Facility (MTF) located in Aberdeen Proving Ground located in Aberdeen, MD.

• As needed you will also cover and travel to the following locations: US Coast Guard Base (Glen Burnie, MD) and other locations throughout Maryland, Washington D.C. and Virginia.

Work Hours : Primarily the work hours will be 7:30 a.m.- 4:30 p.m. EST, Monday through Friday to include potential to work some weekends (Saturday and/or Sunday) and late evenings for briefings and events.

HireVue Statement : As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

WAH Statement :

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$64,600 - $75,000 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, Humana ) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our