Director, Customer Experience

BrightonOne • Boston, MA

5h • $130,000 - $150,000 • Hybrid

About The Position

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 department's budget and staffing model, partners across Operations, Compliance, IT, and Clinical functions, and drives measurable improvement in satisfaction, resolution, and regulatory performance for the plan's Veteran and military-connected membership.

Requirements

• Bachelor's degree in healthcare administration, business, or a related field; Master's 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 in self-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.
• 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.
• Must be able to obtain and maintain U.S. Government personnel security clearance as a condition of employment.
• Candidates must be authorized to work in the United States without sponsorship now or in the future.

Nice To Haves

• Master's degree

Responsibilities

• 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.
• 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.
• 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.
• 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.
• 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.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Director