Humana Employment – 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:

  • 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.
  • 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.
  • 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.
  • Assist in developing and sustaining a high-performing network in designated PSAs/NSPAs which meets TRICARE and Humana Government Business requirements and optimization strategies.

Job Requirements:

  • Willingness to travel and work uncommon hours – involves some overnight travel within North Carolina and weekend hours.
  • Knowledge of the TRICARE program
  • Exceptional public-speaking ability
  • Comprehensive knowledge of Microsoft Office Suite
  • Excellent oral and written communication skills
  • Successfully receive interim approval for government security clearance (eQIP – Electronic Questionnaire for Investigation Processing)
  • Our Department of Defense contract requires U.S. Citizenship
  • Superior organizational skills necessary to effectively manage multiple activities

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

Job Details:

Company: Humana

Vacancy Type: Full Time

Job Location: Boston, MA, US

Application Deadline: N/A

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