Contact Center Representative

Job Type: Full-time

Location: 5 days per week in Brighton MA office

FLSA Status: Non-Exempt

About Us

BrightonOne is a nonprofit social enterprise delivering healthcare housing and hope to veterans and military-connected families with enterprise discipline in service to those who served.

Position Summary

The Contact Center Representative serves as the primary point of contact for members providers and internal partners within the US Family Health Plan (USFHP)atBrightonOne.

This roleis responsible fordelivering exceptional customerand providerservice by handling inbound and outbound calls resolving inquiries and providingaccurateinformation related to benefits eligibility claims referrals and care coordination for military beneficiaries and their familiesand providers.

Key Responsibilities

Customer Service Operations

• Respond to high-volume inbound calls from USFHP members providers and caregivers in a professional empathetic and timely manner.
• Provide accurate information regarding eligibility and enrollment benefits and coverage claims status and billing inquiries and referrals and authorizations.
• Educate members on plan benefits navigation of the healthcare system and available resources.
• Demonstrate a customer-focused and compassionate approach when assisting members and providers.
• Handle sensitive or complex member issues while maintaining professionalism and confidentiality.

Member & Provider Support

• Support care coordination by connecting members with appropriate clinical or case management teams.
• Escalate complex issues or grievances according to established protocols.
• Provide clear and accurate information to help members navigate their healthcare benefits and available resources.
• Maintain a high level of service and professionalism when interacting with military beneficiaries families caregivers and providers.

Documentation & Systems

• Document all member and provider interactions clearly and thoroughly in CRM or member systems.
• Navigate multiple computer systems and applications to research information and resolve inquiries.
• Utilize CRM platforms Microsoft Office and other applicable systems to support daily responsibilities.
• Maintain accurate and timely documentation in accordance with established procedures.

Performance & Compliance

• Meet or exceed key performance indicators (KPIs) including quality productivity and member satisfaction.
• Maintain compliance with HIPAA and all federal state and Department of Defense (DoD) requirements.
• Follow established policies procedures and protocols.
• Perform additional duties as assigned.

Qualifications

Education & Experience

• High school diploma or GED required.
• Associates or Bachelors degree preferred.
• 1 years of customer service experience preferably in a call center healthcare or insurance environment required.
• Experience using computer systems including CRM platforms and Microsoft Office required.
• Experience in healthcare managed care or health insurance especially TRICARE or Medicare/Medicaid is preferred.
• Knowledge of USFHP or military health benefits preferred.
• Experience handling sensitive or complex member issues required.
• Bilingual skills such as Spanish preferred.

Skills & Competencies

• Strong verbal and written communication skills with the ability to explain complex information clearly.
• Strong problem-solving and critical thinking skills.
• Demonstrated commitment to customer service excellence.
• Ability to multitask navigate multiple systems and work effectively in a fast-paced environment.
• Customer-focused with a compassionate service-oriented mindset.
• Strong attention to detail and accuracy.
• Ability to collaborate effectively with team members and adapt to changing priorities.
• Ability to remain calm and professional in high-stress situations.
• Cultural sensitivity particularly when working with military families.

Physical Nature of the Job

This is an onsite contact center role requiring extended periods of sitting computer use and telephone communication. The position requires the ability to work effectively in a fast-paced contact center environment while managing multiple systems and customer interactions.

Equal Opportunity Employer Statement

BrightonOne is an Equal Opportunity Employer. We prohibit discrimination and harassment of any kind based on race color religion sex (including pregnancy gender identity and sexual orientation) national origin age disability genetic information protected veteran status or any other characteristic protected by federal state or local law. We strongly encourage applications from veterans and individuals with disabilities.

Accommodations are available upon request for candidates taking part in all aspects of the selection process.

Work Authorization

Candidates must be authorized to work in the United States without sponsorship now or in the future.