Regional Senior TRICARE Community Liaison

🔥 4 minutes ago

🇺🇸 United States – Remote

💵 $59.3k - $80.9k / year

⏰ Full Time

🟠 Senior

👫 Community Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Represent Humana Military in administering TRICARE services within a defined East Region territory • Provide guidance to nationally contracted healthcare providers and support facilities with footprints across East and West Regions • Develop and sustain relationships with National Health System providers and large health systems • Explain the TRICARE health plan, policies, regulations, and Military Health System navigation • Manage time, set priorities, address inquiries, and resolve straightforward and complex provider problems • Support customer service, conduct outreach, maintain network adequacy and access to care • Manage provider relations and education within the assigned area • Review, investigate, and resolve TRICARE inquiries, complaints, and concerns from beneficiaries, providers, and government personnel • Support implementation of Alternative Payment Methodologies and Demonstration Pilots advancing value-based care • Maintain clear communication and accountability with stakeholders • Assess provider capacity and address network gaps • Deliver guidance to TRICARE beneficiaries, Medical Treatment Facility staff, government officials, and civilian healthcare providers • Complete documentation, transaction processing, and reporting accurately and timely • Perform other duties requested by the supervisor consistent with company objectives

🎯 Requirements

• 2 or more years of experience in TRICARE • Experience in healthcare provider relations, provider management, provider contract negotiations or working with healthcare providers • Experience in customer relationship management with courteous, professional interactions • Experience analyzing information, researching problems, and determining and implementing solutions • Exceptional public-speaking ability • Strong verbal and written communication skills • Comprehensive knowledge of Microsoft Office applications, including Word, Excel, OneNote, and Outlook • Ability to maintain complex spreadsheets in Excel • Superior organizational skills to manage multiple activities • Ability to work effectively and independently without distractions • Experience working with different stakeholders and teams at all organizational levels in a collaborative team environment • U.S. citizenship required • Ability to successfully receive approval for government security clearance via National Background Investigation Services (NBIS) • Must not currently live in Puerto Rico • Bachelor's degree in healthcare administration, business, or related field (preferred) • Experience in managed care, health insurance, or related healthcare field (preferred) • Experience with TRICARE policies and/or the military health care delivery system (preferred) • Experience interpreting policy and government contracts such as TRICARE, Medicare, Medicaid, or CMS (preferred)

🏖️ Benefits

• Bonus incentive plan based upon company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Remote work • Occasional travel to Humana offices for training or meetings • Dedicated home workspace • Internet service meeting minimum speed requirements