Customer Service Rep Sr (Behavioral Health

Join Us in this Amazing Opportunity

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, we encourage you to review and apply today and help us build healthier communities for all.

We are hoping you will join us as a Customer Service Rep Sr (Behavioral Health) and help shape the future of healthcare where you’ll be an integral part of our CS - Medi-Cal Call Center team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders.

This position has been approved to be Partial Telework
.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Customer Service Rep Sr (Behavioral Health) will provide telephonic and in‑person assistance to Cal Optima Health’s Medi‑Cal members and providers regarding the Medi‑Cal One Care Behavioral Health program, eligibility, enrollment, benefits and services. You will conduct prescreening for behavioral health services and safety screening to appropriately triage crisis calls. You will resolve complex issues and handle escalated calls that require additional research with providers, health networks and internal Cal Optima Health departments.

Together, we are building a stronger, more equitable health system.

• 90% - Customer Support
  • Participates in a mission‑driven culture of high‑quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short‑ and long‑term goals/priorities for the department.
  • Addresses member and provider inquiries, questions and concerns in all areas, including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care, in‑person or telephonically.
  • Communicates, builds and maintains internal and external relationships through prompt and accurate service.
  • Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures.
  • Serves as a mediator to ensure the interests of members and Cal Optima Health are protected.
  • Follow‑ups and ensures completion of all member and provider inquiries or requests.
  • Ensures accurate, complete and correct documentation is entered into Facets regarding all issues and/or inquiries, complaints and grievances.
  • Assists in developing and mentoring Customer Service staff.
  • Serves as a resource for other team members or internal stakeholders.
  • Maintains departmental productivity and quality standards.
  • Resolves escalated challenges.
• 10% - Other
  • Completes other projects and duties as assigned.

• High school diploma or equivalent PLUS 2 years of experience in customer/member service, including 1 year call center capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• Typing speed of 35 words per minute (WPM) required.

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

• N/A

• Develop rapport and establish and maintain effective working relationships with Cal Optima Health’s leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicat…