TRICARE Community Liaison

Profile

Description

Responsibilities

The TRICARE Community Liaison (TCL) is a customer-facing Humana Military associate who is knowledgeable, professional and courteous. This role interacts with TRICARE beneficiaries; Medical Treatment Facility (MTF) staff; and civilian healthcare providers and facilities in person and by other means, such as by telephone, e-mail, and chat. The primary focus of the TCL is to develop and sustain strong, collaborative relationships with all TRICARE customers - Government, beneficiaries, and providers. 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 Manager/Consultant in managing the local TRICARE network in designated Prime Service Areas (PSAs) and Non-Prime Service Areas (NPSAs), including participating in network development and optimization strategies. This position may require travel to conduct outreach activities.

Key Accountabilities -


Provide accurate explanation of TRICARE health plan policies and procedures during customer support activities, ensuring compliance with all contract standards.
Respond appropriately and timely to inquiries regarding eligibility, enrollment, billing, claims, referrals/authorizations, network operations, access to care, Defense Health Agency/TRICARE Health Plan policy, and other TRICARE topics.
Research and resolve complex TRICARE problems/issues elevated by a Government agent, beneficiary, or provider within required timelines.
Assist in developing and sustaining a high-performing network in designated PSAs/NSPAs which meets TRICARE and Humana Government Business requirements and optimization strategies.
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.
Participate in activities that promote well-being and professional growth of self and others.


Required Qualifications


Our Department of Defense contract requires U.S. citizenship for this position
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
H.S. Diploma or GED
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
Willingness to travel and work uncommon hours
Exceptional public-speaking ability
Proficient with Microsoft Office products
Excellent oral and written communication skills
Superior organizational skills necessary to effectively manage multiple activities
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Preferred Qualifications


Bachelor's degree
Experience in analyzing information, researching problems, and determining and implementing solutions
Experience in healthcare provider relations


Additional Information

This position will be required to work on site in an office located at Fort Bragg, North Carolina.

Internally this position has the Career Framework title of Consumer Operations Professional 2.

Scheduled Weekly Hours

40

Company info

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