Contact Center Representative

BrightonOne•Boston, MA

3d•$25 - $26•Onsite

About The Position

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.

Requirements

High school diploma or GED required.
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 handling sensitive or complex member issues required.
Candidates must be authorized to work in the United States without sponsorship now or in the future.

Nice To Haves

Associate’s or Bachelor’s degree preferred.
Experience in healthcare, managed care, or health insurance, especially TRICARE or Medicare/Medicaid is preferred.
Knowledge of USFHP or military health benefits preferred.
Bilingual skills, such as Spanish preferred.

Responsibilities

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.
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.
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.
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.