Senior Community Associate
DraftKings Inc.
Community Liaison
Humana
full-time
Posted on:
Location Type: Remote
Location: Remote • Florida • 🇺🇸 United States
Visit company websiteSalary
💰 $58,700 - $68,200 per year
Job Level
JuniorMid-Level
About the role
- Provide accurate explanation of TRICARE health plan policies and procedures during on-site and electronic beneficiary, provider, and Government outreach activities
- 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
- 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
- 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
- Participate in value-based care pilots through effective communication, consultation and support of selected providers
- Accomplish all administrative tasks as assigned, including documenting interactions, processing transactions, and submitting required reports
- 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
- Participate in activities that promote well-being and professional growth of self and others
Requirements
- U.S. Citizenship
- Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
- Must live within 60 miles of Miami, Florida office
- Willingness to travel and work uncommon hours (nights/weekends)
- 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
- Exceptional public-speaking ability
- Comprehensive knowledge of Microsoft Office Suite
Benefits
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
TRICARE health plan policieseligibilityenrollmentbillingclaimsreferralsauthorizationsnetwork operationsaccess to caremarket laydown assessments
Soft skills
customer relationspublic speakingcommunicationproblem-solvingself-managementteam collaborationadministrative skillsconsultationprofessional growthtime management
Certifications
U.S. Citizenship
