Customer Service Rep Sr (Behavioral Health)

We are a mission-driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, join us in building healthier communities for all.

About the role

As a Customer Service Rep Sr (Behavioral Health), you will be an integral part of our CS - Medi-Cal Call Center team, helping to strive for excellence while serving our members with dignity and respect. This position is approved for partial telework, requiring you to work within the State of California and come into the main office in Orange, CA at least two days per week.

You will provide telephonic and in-person assistance to CalOptima Health's Medi-Cal members and providers regarding the Medi-Cal OneCare Behavioral Health program, eligibility, enrollment, benefits, and services. Responsibilities include conducting prescreening for behavioral health services, safety screening to triage crisis calls, resolving complex issues, and handling escalated calls requiring additional research with providers, health networks, and internal departments.

Responsibilities

• Participate in a mission-driven culture focused on high-quality performance, member-focused customer service, consistency, dignity, and accountability.
• Assist the team in carrying out department responsibilities and collaborate with others to support short- and long-term goals.
• Address member and provider inquiries regarding eligibility, enrollment, claims, authorization status, benefit interpretation, and referrals/authorizations for medical care, both in-person and telephonically.
• Communicate, build, and maintain internal and external relationships through prompt and accurate service.
• Identify and communicate challenges using professional judgment while adhering to departmental policies and procedures.
• Serve as a mediator to ensure the interests of members and CalOptima Health are protected.
• Follow up and ensure completion of all member and provider inquiries or requests.
• Ensure accurate, complete, and correct documentation in Facets for all issues, inquiries, complaints, and grievances.
• Assist in developing and mentoring Customer Service staff.
• Serve as a resource for other team members or internal stakeholders.
• Maintain departmental productivity and quality standards.
• Resolve escalated challenges.
• Complete other projects and duties as assigned.

Requirements

• High school diploma or equivalent plus 2 years of experience in customer/member service, including 1 year in a call center capacity; an equivalent combination of education and experience may also qualify.
• Typing speed of 35 words per minute (WPM).

Preferred Qualifications

• 1 year of experience in a health maintenance organization (HMO), Medi-Cal/Medicaid, and health services.
• Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).

Skills

• Develop rapport and maintain effective working relationships with leadership, staff, and external contacts of diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule, including evenings and weekends.
• Organize, analyze, problem-solve, and manage projects.
• Work efficiently in a fast-paced environment and manage multiple projects.
• Identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems.

Physical Requirements

• Ability to visually read information from computer screens, forms, and other printed materials.
• Ability to speak clearly in conversation and general communication.
• Hearing ability for verbal communication via telephone and face-to-face interactions.
• Manual dexterity for typing, writing, standing, reaching, flexibility, body movement (bending, crouching, walking, kneeling), and prolonged sitting.
• Lifting and moving objects, patients, and/or equipment weighing 10 to 25 pounds.

Benefits

• Competitive compensation: Pay Grade 302 - $49,754 - $69,655 ($23.92 - $33.4880 per hour), with final salary based on education, experience, skills, and internal equity.
• Comprehensive benefits package.
• CalPERS pension program and additional retirement packages.
• Generous PTO program.
• Work-life balance initiatives.
• Wellness programs.
• Tuition reimbursement.
• Professional and career development opportunities.
• Flexible scheduling.

Schedule

This position is approved for partial telework, requiring work within the State of California and in-office attendance in Orange, CA at least two days per week. Flexible scheduling may be required, including evenings and weekends.

Work Environment

Work is typically indoors and sedentary, subject to schedule changes and variable work hours, with occasional travel. The noise level is usually moderate. If located at PACE, work may involve a clinical setting serving the frail and elderly, with potential exposure to harmful or hazardous conditions and moderate to loud noise levels. Community-based roles may require occasional outdoor work in varied temperatures.