The Senior 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 Senior TCL is to develop and sustain strong, collaborative relationships with all TRICARE customers in the East Region – Government, beneficiaries, and providers. The Senior 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 three to four MTFs. Through clear and concise communication, the Senior TCL is responsible for ensuring MTF, beneficiary, and provider understanding of the TRICARE health plan and how to navigate the Military Health System. The Senior TCL also supports the Health System 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 Senior TCL is self-directed and uses independent, critical decision-making in managing time, setting priorities, addressing general inquiries, and resolving both straightforward inquires and complicated problems and concerns raised by beneficiaries, providers, and Government customers. The Senior 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 Leader. This position will require work during uncommon duty hours and travel to conduct outreach activities.
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 procuring the network discount goal assigned to each PSA/NPSA 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.
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.
Our Department of Defense Contract requires U.S. citizenship for this position.
Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service)
Must live within a 60 minute commute of the Quantico, VA office, as this position will require working in the office 2 - 3 times a week, and travelling to other offices in the region
This position will require the ability to travel and work on weekends/nights as needed to provide briefings
Experience in customer relationship management, demonstrating courteous, professional interactions
Experience in analyzing information, researching problems, and determining and implementing solutions
Experience in healthcare provider relations
Three to four years’ experience in TRICARE, including presentations to groups
Knowledge of healthcare provider contract negotiations
Work style -
Hybrid home - will be working at the Quantico, VA and other regional offices 2 - 3 times a week, the rest of the time will be from home
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.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.$65,200 - $89,000 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.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.
Originally posted on Himalayas
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