Call Center Representative

Job Type: Full-time 7:45am – 4:15pm OR 9:45am – 6:15pm 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) at BrightonOne. This role is responsible for delivering exceptional customer and provider service by handling inbound and outbound calls, resolving inquiries, and providing accurate information related to benefits, eligibility, claims, referrals, and care coordination for military beneficiaries and their families and 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. Associate’s or Bachelor’s 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. 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. #J-18808-Ljbffr