Senior TRICARE Community Liaison

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $59.3k - $80.9k / year

⏰ Full Time

🟠 Senior

👫 Community Manager

🦅 H1B Visa Sponsor

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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

• Provide expert guidance to nationally contracted healthcare providers and support facilities with footprints across East and West Regions • Develop and sustain collaborative relationships with National Health System providers in the East Region • Cover all National contracted providers and large health systems regardless of location or type of care • Explain the TRICARE health plan, TRICARE policies and regulations, and navigation of the Military Health System • Manage time, set priorities, address inquiries, and resolve straightforward and complex provider problems and concerns • Uphold operational standards and consistent, high-quality delivery of TRICARE services • Support customer service and conduct stakeholder outreach • Maintain network adequacy and access to care • Manage provider relations and education • Lead review, investigation, and resolution of TRICARE inquiries, complaints, and concerns • Deliver guidance and support to beneficiaries, Medical Treatment Facility staff, government officials, and civilian healthcare providers • Establish and maintain productive relationships and clear communication with stakeholders • Support implementation of Alternative Payment Methodologies and Demonstration Pilots advancing value-based care • Complete documentation, transaction processing, and reporting accurately and timely • Perform other duties requested by the supervisor consistent with company objectives

🎯 Requirements

• Bachelor's degree in healthcare administration, business or related field • 4 or more years of experience in TRICARE • Experience in healthcare provider relations, provider management, provider contract negotiations or any experience working with healthcare providers • Experience in customer relationship management, demonstrating courteous, professional interactions • Experience in analyzing information, researching problems, and determining and implementing solutions • Exceptional public-speaking ability and 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 necessary to effectively manage multiple activities • Ability to work effectively and independently without distractions • Experience working with different stakeholders and teams at all levels in the organization in a collaborative, team environment • U.S. citizenship required • Successfully receive approval for government security clearance via National Background Investigation Services (NBIS) • Must not currently live in Puerto Rico • Preferred: experience within a 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, including TRICARE, Medicare, Medicaid and CMS

🏖️ 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 • Home or hybrid home/office work arrangement • Remote work • Occasional travel to Humana offices for training or meetings