Health Net, Inc. (NYSE: HNT) is among the nation's largest publicly traded managed health care companies. Health Net's mission is to help people be healthy, secure and comfortable. The company's POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company's Web site at www.healthnet.com



JOB SUMMARY:


Associate is the primary face-to-face point of contact for TRICARE beneficiaries in the field. Provides general program information, on-site benefit counseling, referral for care support, Clearly Legible Report (CLR) program support, and claims and enrollment support services to walk-in customers in the TRICARE Service Center (TSC). Provides appropriate program education as part of each beneficiary interaction. May be required to conduct training or briefing sessions to groups outside of the TSC location. Associate works primarily in the TSC and reports to the Site Manager.



ESSENTIAL DUTIES AND RESPONSIBILITIES:

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Beneficiary Support Services - Associate provides on-site assistance and support services to TSC walk-in customers.
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Provides beneficiaries and Military Treatment Facility employees with general program information on the TRICARE program and focused benefit counseling tailored to the beneficiary's concern or situation.
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Provides assistance with the referral and authorization for care process, clearly legible report (CLR) process support, claims issues and the TRICARE enrollment process.
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Advises beneficiaries of primary care manager choices and enforces MTF, Regional Director and program enrollment guidelines.
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MTF Commander Customer Service Support Requirements and Beneficiary Education- Provides required assistance to fulfill MTF commander customer service support requirements including physician and administrative staff training, in-processing briefing and enrollment activity support, and general TRICARE briefing support.
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Maintains schedules, completes workload reports, attends meetings, orders supplies and marketing materials, and performs general administrative functions to keep TSC fully operational.

Qualifications


REQUIREMENTS:



Education:

High School diploma or equivalent.



Certification/License:



Experience:

* Minimum 2 years customer or member services experience in a health plan.
* MCSC experience in a TRICARE Service Center or Call Center environment preferred.
* Previous medical office, insurance industry, or HMO claims experience.
* Minimum 6 months data entry experience.

Knowledge, Skills & Abilities:

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Thorough understanding of the TRICARE Program and benefit structure.
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Thorough understanding of TRICARE enrollment, DEERS and claims processing requirements and procedures.
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Ability to read, comprehend and explain benefits in a clear, concise, courteous and professional manner.
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Excellent written and verbal communication skills, to include ability to conduct presentations with question and answer sessions.
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Excellent computer skills to include through understanding of Microsoft 2000, Windows 2000 or similar applications.
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Must be able to accommodate occasional travel away from home location to provide relief for other TSCs or to receive training.

As a government contractor, this position requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF85P or higher security.



OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.



Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.