TRICARE Community Liaison

Humana•Village of Highland Falls, NY

6d•Remote

About The Position

Are you looking to join a team where you can be a part of our important mission of supporting the TRICARE healthcare program for our nation's military? Humana Government Business is a top 10 Department of Defense contractor, with a long history in the TRICARE business and has been awarded the T-5 East Region, the next generation of military health contracts. 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 cover specific Health System Areas comprised of Prime Service Areas (PSAs) and Non-Prime Service Areas (NPSAs), the associate’s area of responsibility can average more than 62,000 beneficiaries, 8,000 network providers, dozens of National Guard/Reserve units, and three to four MTFs within a geographic territory that may cover over 43,000 square miles. Through clear and concise communication, the 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 generate revenue for the company and increase healthcare trend and discount incentives paid by the Government.

Requirements

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

Nice To Haves

Experience in analyzing information, researching problems, and determining and implementing solutions
Experience in healthcare provider relations
Knowledge of the TRICARE program

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.

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.

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