[Hiring] Regional Senior TRICARE Community Liaison @Humana

Role Description

The Regional Senior TRICARE Community Liaison (TCL) is an important Humana Military representative committed to operational excellence, consistency, and accountability in the administration of TRICARE services within a defined territory in the East Region. You will provide expert guidance to nationally contracted healthcare providers and support facilities who have footprints across both East and West Regions.

The primary focus of the Regional Senior TCL is to develop and sustain strong, collaborative relationships with all National Health System providers in the East Region. You will cover all National contracted providers and large health systems regardless of location or type of care provided. Through clear and concise written and verbal communication, the Regional Senior TCL ensures provider understanding of the TRICARE health plan, TRICARE Policy and Regulations and how to navigate the Military Health System. The Regional Senior TCL is self-directed and uses independent, critical decision-making in managing time, setting priorities, addressing general inquiries, and resolving both straightforward inquiries, complicated problems and concerns raised by providers. This position upholds rigorous operational standards and ensures consistent, high-quality delivery of TRICARE services. You will support customer service, conduct outreach, maintain network adequacy and access to care. You will manage provider relations and education, and ensure effective provider management within the assigned area. You will lead the review of TRICARE inquiries, complaints, and concerns from beneficiaries, providers, and government personnel, ensuring a resolution through professionalism and integrity.

Additional responsibilities involve supporting the implementation of Alternative Payment Methodologies and Demonstration Pilots that advance value-based care initiatives. You will establish and maintain productive relationships and clear communication with all stakeholders, ensuring accountability and excellence in every interaction.

KEY ACCOUNTABILITIES

• 30% Network Adequacy, Provider Management, and Access to Care: Maintain and assess network adequacy, ensure access to care, and manage provider relations and education within the assigned territory. Support ongoing evaluation of provider capacity and address network gaps, ensuring consistency and accountability in network performance.
• 25% Resolution of TRICARE Inquiries and Issues: Lead the review, investigation, and resolution of TRICARE inquiries, complaints, and concerns from beneficiaries, providers, and government personnel. Ensure all cases are managed with accuracy and in compliance with established standards.
• 20% Customer Service and Stakeholder Outreach: Deliver expert guidance and support to TRICARE beneficiaries, Medical Treatment Facility staff, government officials, and civilian healthcare providers. Conduct outreach activities to educate and engage stakeholders, upholding rigorous operational standards and consistent service delivery.
• 15% Relationship Management and Communication: Establish, foster, and maintain productive relationships with all TRICARE stakeholders. Ensure clear, consistent, and professional communication to promote operational excellence and accountability.
• 5% Support for Value-Based Care and Program Innovation: Contribute to the implementation of Alternative Payment Methodologies and Demonstration Pilots that advance value-based care initiatives, ensuring accuracy and accountability in all program activities.
• 5% Administrative and Compliance Tasks: Complete required documentation, transaction processing, and reporting accurately and in a timely manner, supporting compliance and data integrity.

This role description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives.

Qualifications

• 2 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 (can maintain complex spreadsheets), OneNote and Outlook
• Superior organizational skills necessary to effectively manage multiple activities
• Self-starter who can work effectively and independently without distractions
• Experience working with different stakeholders and teams at all levels in the organization in a collaborative, team environment
• Our Department of Defense Contract requires U.S. citizenship for this position
• Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS)
• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico

Preferred Qualifications

• Bachelor's degree in healthcare administration, business or related field
• Experience working within a managed care, health insurance or related healthcare field
• Experience with TRICARE policies and/or the military health care delivery system
• Experience interpreting policy and government contracts (I.E. TRICARE, Medicare, Medicaid, CMS etc....)

Work Style

• Remote
• Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

• 40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

• $59,300 - $80,900 per year
• This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Benefits

• Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline

• 10-02-2026

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.