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 Service Center (TSC) Administrator is responsible for the operations and functions of the TSC, to include the customer service, referral and enrollment functions, and supervising the staff assigned to the TSC. The Administrator also plays a key Military Treatment Facility (MTF) liaison role in daily interface with the MTF staff to ensure process integration and optimization of MTF resources. The Administrator monitors and reports changes in MTF capacity and capability that may impact balanced workload agreements, enrollment capacity and network development requirements. The Administrator may also supervise smaller TSCs in the Market. Manages the MTF monthly 40 person-hours customer service support requirement to include beneficiary briefings and MTF provider education and other TRICARE Operations Manual (TOM) and proposal-required briefing support in the assigned market. May serve as a member or leader of Service Assistance Teams (SAT) to include planning, preparation, deployment and operation of teams to provide mobile customer service functions. The TSC Administrator reports to the Market Manager.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Supervises and directs TSC operations and work activities of assigned personnel for the customer service, education, referral and enrollment functions.
- Ensures TSC associates are appropriately trained and adhere to written policies and procedures.
- Ensures equipment and facilities are operational.
- Ensures compliance with company directives and ensures required reports are accurate and submitted timely. Provides occasional briefing support at local or remote TOM and proposal-required events.
- Performs daily analysis of MTF capabilities and capacities and adjusts the MTF balanced workload agreement, MTF Capability Table and other business rules to ensure accuracy of referrals and optimal use of the MTF.
- Coordinates closely with MTF points of contact for referral and enrollment functions to ensure local processes and procedures are integrated and operate effectively and efficiently.
- Ensures TSC compliance with program requirements, performs audits, identifies areas for improvement and participates on the teams convened to analyze process issues and correct any areas of vulnerability.
- Performs or supports required quality assurance activities as prescribed by the Quality Office and functional business owners.
- Elevates program management issues to the Market Manager for further correction.
- Updates and maintains accuracy of local contingency, disaster planning and SAT documents.
- Participates in required Installation-level and Regional contingency exercises.
- Other duties as assigned.
Bachelor's Degree in Business, Health Administration or related health care field preferred
Knowledge, Skills & Abilities:
- Five years TRICARE Service Center customer service experience, or related customer service experience
- Five years experience working within military healthcare system required, with previous military service preferred
- Five years associate supervision 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, Managed Care Support Contractor (MCSC) Contract and the military healthcare system to include MCSC MTF interface and support requirements, optimization, care coordination and contingency planning
- Expert knowledge of TSC operations, support systems, applicable TRICARE Manuals and reporting requirements to include customer service, eligibility and benefits, claims assistance, enrollment application processing, referral processing, and beneficiary and MTF provider education
- Must have valid driver's license, reliable personal transportation and ability to travel and work occasional evenings, weekends and overnight stays at remote locations supporting briefings and customer service support events for SAT deployments and Guard and Reserve
- Strong leadership, supervisory and team building skills
- Outstanding verbal and written communication skills
- Ability to analyze and interpret work-related data, manage workload variations and develop local plans and procedures to ensure service delivery and operations during contingencies
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.
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.
- 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.
- 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 travelmay be required between work sites and/or out of area.
- 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).
- Moderate 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, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.
Health Net - 7 months ago