Director, Customer Experience

About BrightonOne

BrightonOne functions as a nonprofit social enterprise dedicated to providing comprehensive healthcare, housing, and support to veterans and military-related families, combining enterprise discipline with a mission to serve those who have served.

Position Overview

The Director of Customer Experience is responsible for managing the full spectrum of beneficiary and provider interactions for the USFHP plan, overseeing service, digital platforms, and operational contact points. Reporting directly to the Chief Operating Officer / VP of Health Plan Operations & Compliance, the role includes leadership over member and provider portals, grievances and appeals, billing and enrollment functions, ensuring timely, accurate, compliant, and service-focused engagement. This leadership role includes strategic direction, budget management, staffing oversight, and collaboration with various departments including Operations, Compliance, IT, and Clinical divisions to enhance satisfaction, issue resolution, and regulatory compliance for veterans and military-connected members.

Key Responsibilities

• Establish and oversee a multi-channel customer service approach across phone, digital applications, written, and escalation pathways, enforcing KPIs related to first-contact resolution, response speed, and satisfaction metrics.
• Manage departmental budget, workforce planning, and productivity standards by forecasting workload in line with membership and communication volumes.
• Utilize customer feedback, complaint data, and satisfaction outcomes to prioritize enhancements in policies, processes, and technologies.
• Serve as the ultimate authority for escalated, complex beneficiary and provider cases, ensuring root cause analyses and resolution follow-up.
• Supervise grievances, appeals, and priority correspondence processes to ensure compliance with TRICARE/USFHP regulations regarding timelines and documentation.
• Maintain audit-ready information and reporting concerning grievances and complaint trends, driving corrective actions for underlying systemic issues.
• Collaborate with Compliance, Legal, Claims departments, and Medical Director on appeals and regulatory inquiries.
• Oversee functional and technical aspects of member and provider digital portals, working with IT and service vendors to enhance functionality, fix defects, and test releases.
• Ensure accuracy, accessibility, and compliance of portal content, self-service capabilities, and secure messaging.
• Promote adoption of digital self-service tools to enhance user experience and reduce unnecessary contacts.
• Partner with Associate Director of contact center operations to develop and manage quality assurance and training programs within the Contact Center.
• Drive performance quality standards among internal and partner teams, suggesting improvements to boost accountability and engagement.
• Lead or contribute to process improvement initiatives using data-driven analysis, cost/benefit evaluations, and joint problem-solving methods.
• Assist in recruitment, training, and development of staff to meet service levels aligned with USFHP/TRICARE contractual obligations and policies.
• Oversee billing and enrollment operations ensuring accuracy, timeliness, and regulatory adherence to TRICARE eligibility provisions.
• Monitor enrollment processes for data integrity and compliance, resolving escalated issues and discrepancies.
• Directly manage the customer experience and escalation team including hiring, coaching, performance evaluation, and staff development.
• Create and enhance training, quality monitoring, and career growth frameworks to ensure consistent service quality and improved team capabilities.
• Cultivate a workplace culture emphasizing responsibility, empathy, and dedication to veteran and military-connected family service.

Qualifications

• Bachelor’s degree in healthcare administration, business, or related area is required; a Master's degree is preferred.
• At least ten years of advancing experience in health plan member or customer experience, service, or operations with demonstrated team leadership.
• Proven track record of implementing engagement solutions that increase self-service adoption, automation, operational efficiency, and enhance business results.
• Hands-on expertise managing grievances, appeals, escalations, billing, enrollment, and member/provider portals within managed care settings.
• In-depth understanding of managed care operational frameworks, service metrics, and regulatory grievance requirements.
• Strong skills in leadership, budgeting, and workforce planning.
• Ability to utilize data for performance measurement and continuous service improvement.
• Competence with CRM, telephony, and portal technologies.
• Excellent communication, conflict de-escalation, and collaboration skills across departments.
• Firm commitment to veteran-centered and patient-focused service.

Additional Requirements

• Must be eligible and able to maintain U.S. Government personnel security clearance for employment.

Physical Demands

The job involves predominantly sedentary activities, though employees will occasionally be required to stand or move around the campus.

Equal Opportunity

BrightonOne is committed to equal employment opportunities, prohibiting any discrimination or harassment based on protected characteristics. The organization encourages applications particularly from veterans and individuals with disabilities and provides required accommodations during recruitment processes.

Work Authorization

Candidates must possess authorization to work in the United States without need for sponsorship now or in the future.

Salary

The position offers an annual salary in the range of $130,000 to $150,000.