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The TRICARE Community Liaison (TCL)- is a customer-facing Humana Military associate who is knowledgeable, professional, and courteous. This role interacts in person and by other means, such as by telephone, e-mail, and chat with TRICARE beneficiaries, Medical Treatment Facility (MTF) and other Government staff, including senior military leaders, and civilian healthcare providers and facilities. The primary focus of the TCL is to develop and sustain strong, collaborative relationships with all TRICARE customers in the East Region – Government, beneficiaries, and providers. The TCL must be cognizant of the military way of life during all interactions, including the impact of stress, trauma, and loss on active, reserve component and retired service members and their families that result from military operations. Assigned to specific Health System Areas comprised of Prime Service Areas (PSAs) and Non-Prime Service Areas (NPSAs) in a geography that may span over 43,000 square miles, the team’s area of responsibility can include an average of more than 100,000 beneficiaries, 50,000-70,000 network and non-network providers, numerous National Guard/Reserve units, and two to three MTFs.

Through clear and concise communication, the TRICARE Community Liaison (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 Operations Leader in local TRICARE network operations, including participating in network development and optimization strategies which focus on a medically ready force and a ready medical force. The TCL requires little supervision and uses independent, critical decision-making in managing time, setting priorities, addressing general inquiries, and resolving both straightforward inquiries and complicated problems and concerns raised by beneficiaries, providers, and Government customers. The TCL may be designated as an embedded associate at an MTF and may be requested to provide back-up coverage in the absence of the Health System Operations Leader. This position will require work during uncommon duty hours and travel to conduct outreach activities.

KEY ACCOUNTABILITIES

45%    Provide accurate explanation of TRICARE health plan policies and procedures during on-site and electronic outreach activities, ensuring compliance with all customer support performance standards. Outreach activities will include interactions with beneficiaries in all categories, no matter the TRICARE plan, network and non-network providers, Military Health System staff, local Military and Veterans Support Organizations (MSOs/VSOs), and at venues related to military and family readiness

20%    Respond in precise, comprehensive and timely manner to beneficiary, provider, and Government inquiries (whether received electronically, in hard copy or in person) regarding eligibility, enrollment, billing, claims, referrals/authorizations, appointment assistance, 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.

10%    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 achieving the network discount goal 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. Participate in value-based care pilots through effective communication, consultation, and support of selected providers.

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 determ