Humana

Tricare Community Liaison

District of Columbia, United States

Not SpecifiedCompensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Military HealthIndustries

Requirements

The TRICARE Community Liaison must be knowledgeable, professional, and courteous, with the ability to interact with TRICARE beneficiaries, Medical Treatment Facility (MTF) and Government staff, including senior military leaders, and civilian healthcare providers. A strong understanding of the military way of life, including the impact of stress, trauma, and loss on service members and their families, is essential. The role requires independent, critical decision-making, minimal supervision, and the ability to manage time and set priorities effectively. This position also requires work during uncommon duty hours and travel for outreach activities.

Responsibilities

The TRICARE Community Liaison is responsible for developing and sustaining strong, collaborative relationships with all TRICARE customers in the East Region, including Government, beneficiaries, and providers. They will ensure understanding of the TRICARE health plan and how to navigate the Military Health System through clear and concise communication. Responsibilities include providing accurate explanations of TRICARE health plan policies and procedures during outreach, responding to inquiries regarding eligibility, enrollment, billing, claims, referrals/authorizations, network operations, access to care, and policy. The liaison will also research and resolve complex TRICARE problems, assist in developing and sustaining a high-performing network, and support the Health System Operations Leader in local TRICARE network operations, including network development and optimization strategies. Additionally, the role involves processing and correcting general eligibility, enrollment, billing, claims, referral/authorization, and network difficulties, and may require back-up coverage for the Health System Operations Leader.

Skills

Customer Service
Communication
Relationship Management
Problem-Solving
Critical Thinking
TRICARE Health Plan
Military Health System
Network Development
Time Management
Prioritization

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.
Rising medical costs and tightening Medicare reimbursements may strain financial performance.
Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.
The company emphasizes inclusivity, offering free language interpreter services for accessibility.
Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.
The company is the first insurer to cover TMS therapy for adolescent depression.
Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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