Director, Customer Experience

Title: Director Customer Experience

Job Type: Full-time

Location: Hybrid 4 days per week in Brighton MA office; 1 day remote

FLSA Status: 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 Overview

The Director Customer Experience leads the beneficiary and provider experience for USFHP with end-to-end accountability for the service digital and operational touchpoints that shape how members and providers interact with the plan. Reporting to the Chief Operating Officer / VP Health Plan Operations & Compliance the Director provides strategic and technical oversight of member and provider portals the grievances and appeals functions and billing and enrollment operations ensuring every interaction is timely accurate compliant and service-oriented. Operating at a departmental level the Director sets service strategy and standards owns the departments budget and staffing model partners across Operations Compliance IT and Clinical functions and drives measurable improvement in satisfaction resolution and regulatory performance for the plans Veteran and military-connected membership.

Key Responsibilities

Customer Experience Strategy & Oversight

• Define and manage the multi-channel service strategy (phone app/portal written and escalation) and the governing standards KPIs and SLAs including first-contact resolution response and resolution timeliness and member/provider satisfaction.
• Develop the department operating budget staffing model and productivity/quality standards; forecast capacity against membership and contact-volume trends.
• Translate all voice-of-customer data complaint trends and satisfaction results into prioritized processes policies and technology improvements.
• Serve as the senior escalation authority for complex or sensitive beneficiary and provider issues ensuring root-cause resolution and follow-through.

Grievances & Appeals

• Direct the grievances appeals and priority correspondence intake and resolution tracking functions ensuring intake routing resolution and member notification meet TRICARE/USFHP and regulatory timeliness and documentation requirements.
• Maintain audit-ready records case files and reporting on grievances appeals member and provider pain points and complaint trends; identify systemic drivers and drive corrective action.
• Partner with Compliance Legal Claims and the Medical Director on clinical and factual appeals adverse determinations and regulatory inquiries.

Technical Oversight

• Provide technical and functional oversight of member and provider portals partnering with IT and vendors on capability expansion usability defect resolution and release testing.
• Ensure portal content self-service tools and secure messaging are accurate accessible and aligned with plan policy and accessibility standards.
• Champion digital self-service adoption to improve experience and reduce avoidable contacts.

Quality Oversight & Process Improvement

• Work with Associate Director of contact center operations to build and administer Contact Center quality and training programs
• Manages internal and partner performance quality standards recommending improvements to foster accountability and engagement.
• Leads or participates in improvement projects performs cost/benefit analysis. Executes projects and initiates joint problem-solving using data analysis tools performance measurements and decision-making processes.
• Assists with staffing training and developing staff to attain service-level requirements of the USFHP/TRICARE program in line with contract policies and procedures.

Billing & Enrollment Oversight

• Oversee Billing and enrollment operations ensuring accuracy timeliness and alignment with TRICARE eligibility rules and policies.
• Monitor enrollment and disenrollment workflows for data integrity and regulatory compliance; resolve escalations and reconcile discrepancies.

Leadership & Team Management

• Directly lead the customer experience and escalations team; recruit coach evaluate and develop team members.
• Build training quality-monitoring and career-development programs that raise service consistency and staff capability.
• Foster a service culture grounded in accountability empathy and commitment to veterans and military-connected families.

Qualifications

Education & Experience

• Bachelors degree in healthcare administration business or a related field; Masters degree preferred.
• 10 or more years of progressive experience in health plan member/customer experience service operations or health plan operations including team leadership.
• Proven success delivering customer engagement solutions that drive measurable improvements inself-service adoption automation customer experience operational efficiency and business outcomes.
• Proven experience with grievances and appeals escalations billing and enrollment/eligibility and member/provider portals in a managed care environment.

Skills & Competencies

• Deep knowledge of managed care operations service metrics and regulatory grievance/appeal requirements.
• Strong leadership budgeting and workforce-planning capability.
• Data-driven approach to service performance and continuous improvement.
• Proficiency with CRM/service platforms telephony and portal technologies.
• Excellent communication de-escalation and cross-functional partnership skills.
• Commitment to patient-centered veteran-focused service.

Other Requirements

• Must be able to obtain and maintain U.S. Government personnel security clearance as a condition of employment.

Physical Nature of the Job

Some elements of the job are sedentary but the employee will be required to stand for periods of time or move throughout the campus.

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.