Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. Health Net, through its subsidiaries, provides and administers health benefits to approximately 5.4 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, U.S. Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 4.9 million individuals, including Health Net's own health plan members. Health Net's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
For more information on Health Net, Inc., please visit the company's website at
The TRICARE Enrollment and Benefits Specialist is the primary customer service support representative for TRICARE beneficiaries in the TRICARE Service Center (TSC). This associate provides general program information, on-site benefit counseling, access to care support, claims and enrollment support services to walk-in customers in the TSC. The Specialist provides appropriate program education as part of each beneficiary interaction. The Specialist may also serve as a member of a Service Assist Team (SAT) providing mobile customer service support. The Specialist may report to a Lead, TSC Administrator or Market Manager I.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Provide on site customer service support to TSC walk-in customers with enrollment, benefits, access to care and claims issues.
- Keeps up-to-date on Military Treatment Facility (MTF) priorities and initiatives and TRICARE Program changes to enable accurate and timely information sharing.
- Delivers personalized information and assists with coordination in complex enrollment, access and claims problems.
- Performs other TSC customer service support functions and administrative duties (such as data entry of referrals) as assigned
- May perform job duties from various locations within the market area.
- May travel with short notice, for a short term stay of one to four weeks to perform duties at an alternate work location.
- Other duties as assigned
High School diploma or equivalent; some college course work preferred
Valid state driver's license
Knowledge, Skills & Abilities:
- Managed Care Support Contractor (MCSC) experience in a TRICARE Service Center or Call Center environment is preferred, or minimum two years customer or member services experience in a health plan
- Previous medical office, insurance industry, or HMO claims experience is important
- Minimum six months data entry experience
As a government contractor, this position requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security.
- Thorough understanding of the TRICARE Program, benefit structure, TRICARE enrollment, DEERS and claims processing requirements and procedures preferred
- Ability to read, comprehend and explain benefits in a clear, concise, courteous and professional manner
- Knowledge of medical terminology
- Excellent interpersonal, written and verbal communication skills
- Must be a flexible team player with ability to perform in a fast-paced customer service environment
- Ability to data enter referrals and authorizations in the Medical Management system
- Excellent computer skills, including thorough understanding of Microsoft, Windows or similar applications
- Ability to accommodate occasional travel away from home location for SAT participation, to provide relief staffing for other TSCs, or to receive training
- Must have reliable personal transportation; able to travel to and work from various TRICARE Service Centers within assigned market area
- Able to travel to occasional assignments requiring overnight stays of one to four weeks at alternate work locations within or outside of assigned market area
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
The following section describes the general physical requirements for this position. Please note that 'constant' refers to more than 81% of time; 'significant' refers to 40-80%; and 'moderate' refers to 20-40% of the time.
- Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
- Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
- May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays)
- May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.
- Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.
- Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
- Required to have hearing ability to receive detailed information through oral communication
- Required to have speaking ability to express or exchange ideas.
- Constant concentration may be required on various subjects by listening, reading and thinking clearly.
Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
- Interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions.
- Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next.
- Constant computer usage including typing and/or eye strain.
- Constant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry).
- Moderate phone usage; headsets may be required.
- Moderate lifting may be required. May need to lift, carry and/or move equipment/supplies weighing up to 35 pounds, always using safe lifting techniques.
- Constant amount of time spent working in a loud office environment with frequent interruptions/distractions.
- Constant sedentary work (desk bound or seated).
- Constant reading is required via computer screen and/or bound printed materials.
- Moderate walking/standing may be required. Walking and/or transporting supplies and equipment between buildings/parking lots and structures may be required.
Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.
Health Net - 15 months ago