Responsibilities
Must be a United States citizen to be considered for this role.
50%
Provide accurate explanation of TRICARE health plan policies and procedures during on-site and electronic beneficiary, provider, and Government outreach activities, ensuring compliance with all customer support performance standards for the dual purposes of maximizing TRICARE customer satisfaction and the incentives paid by the Government, and of sustaining Humana Military’s competitive advantage for future contracts.
20%
Respond in precise, comprehensive and timely manner to beneficiary, provider, and Government inquiries regarding eligibility, enrollment, billing, claims, referrals/authorizations, network operations, access to care, Defense Health Agency/TRICARE Health Plan policy, and other TRICARE topics. Implement, track and complete self-managed tasks to process and correct uncomplicated general eligibility, enrollment, billing, claims, referral/ authorization, and network difficulties experienced by TRICARE customers.
10%
Research and resolve difficult, complex TRICARE problems/issues elevated by a Government agent, beneficiary, or provider within required timelines. Implement self-directed activities to analyze, coordinate, process, and complete action to correct multifaceted problems relating to eligibility, enrollment, billing, claims, referrals/authorizations, network operations, access to care, Defense Health Agency/TRICARE Health Plan policy, and other TRICARE topics.
5%
Assist in developing and sustaining a high-performing network in designated PSAs/NSPAs which meets TRICARE and Humana Government Business requirements and optimization strategies. Contribute in procuring the network discount goal assigned to each PSA/NPSA that results in annual financial incentives awarded by the Government. Conduct regular and ad hoc market laydown assessments to determine the capability and capacity of TRICARE providers, identifying and implementing action to address any gaps in the network.
5%
Accomplish all administrative tasks as assigned, including documenting interactions, processing transactions, and submitting required reports.
5%
Respond to and assist in contingency operations in support of the MTF and network as needed. Conduct urgent market laydown assessments to determine the capability and capacity of TRICARE providers, identifying and implementing action to accommodate changes in MTF services.
5%
Participate in activities that promote well-being and professional growth of self and others.
Required Qualifications
High School degree
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. Ability to manage multiple or competing priorities and work in a very fast-paced environment
Willingness to travel and work uncommon hours
Excellent interpersonal skills and ability to develop collaborative working relationships across multiple functional areas in the organization or with consumers
Consultative skills which include ability to assess, understand the consumer and make recommendations
Ability to work independently
Comprehensive knowledge of Microsoft Office Suite to include Word, Excel, PowerPoint and Access
Preferred Qualifications
Organizational skills necessary to effectively manage multiple activities
Knowledge of the TRICARE program
Project Management experience
Additional Information
Must be a United States citizen.
Scheduled Weekly Hours
40