Saturday , November 25 2023

Health Insurance Careers – Community Liaison

Website Humana

Job Description:

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.

Job Responsibilities:

  • Assist in developing and sustaining a high-performing network in designated PSAs/NSPAs which meets TRICARE and Humana Government Business requirements and optimization strategies.
  • Research and resolve complex TRICARE problems/issues elevated by a Government agent, beneficiary, or provider within required timelines.
  • Respond to and assist in contingency operations in support of the MTF and network as needed.
  • Accomplish all administrative tasks as assigned, including documenting interactions, processing transactions, and submitting required reports.
  • Participate in activities that promote well-being and professional growth of self and others.
  • 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.
  • Provide accurate explanation of TRICARE health plan policies and procedures during customer support activities, ensuring compliance with all contract standards.

Job Requirements:

  • Organizational skills necessary to effectively manage multiple activities
  • Comprehensive knowledge of Microsoft Office Suite
  • Successfully receive interim approval for government security clearance (eQIP – Electronic Questionnaire for Investigation Processing)
  • Excellent oral and written communication skills
  • Superior organizational skills necessary to effectively manage multiple activities
  • Exceptional public-speaking ability
  • Some travel out of san Antonio area but within the state of TX may be required
  • This position will require the ability to travel and work on weekends/uncommon hours as needed to provide briefings (primarily at Randolph, possibly assist with Lackland and Brook Army Medical Center/Fort Sam)

Qualification & Experience:

  • Experience in handling high volume customer contacts in a courteous and professional manner
  • One or two years’ experience in customer relations, public contact position, and/or TRICARE, including presentations to groups
  • Project Management experience
  • Experience with medical claims/health insurance

Job Details:

Company: Humana

Vacancy Type: Full Time

Job Location: San Antonio, TX, US

Application Deadline: N/A

Apply Here