Behavioral Health Customer Care Representative I

Anticipated End Date:

2025-10-01

Position Title:

Behavioral Health Customer Care Representative I

Job Description:

Behavioral Health Customer Care Representative I

Location: Virtual, this role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Hours: Monday - Friday, an 8 hour shift between hours of 8 am - 8 pm.

The Behavioral Health Customer Care Representative I is responsible for successfully completing the required training in order to perform basic job functions. The main function will be answering incoming Behavioral Health and/or Employee Assistance Program calls, as well as making outbound calls to members or providers.

How will you make an impact: 

• Responds to internal and external customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.

• Completing intake procedure and determine whether member needs to be screened for safety.

• Provide information regarding member’s Behavioral Health, Employee Assistance Program, and Worklife referrals available to member and dependents.

• Operates a PC and laptop with dual monitors to obtain and extract information; documents information, activities and changes in the database.

• Analyze problems provide with information and solutions.

• Documents each call/inquiry received either from members, providers, employers and/or others calling in for tracking and analysis.

• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

• Researches and analyzes data to address operational challenges and customer service issues.

• Process external and internal information member or providers provide in order to process payment for services.

• Under immediate supervision, receives and places follow-up telephone calls / e-mails to answer customer questions that are routine in nature.

• Uses computerized systems for tracking, information gathering and troubleshooting.

• Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.

• Additional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.  

• Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.  

• Performs other duties as assigned.  

• Requires knowledge of company, department, services and products in order to service members and process requests to assure services are rendered and appropriately handles.

• Follows company and department policies and procedures in order to complete and pass monthly audit/call reviews.

• Complete weekly or monthly assignments and trainings as part of the monthly and yearly review.

Minimum Requirements:

• Requires a HS diploma or equivalent and previous experience in an automated customer service environment; or any combination of education and experience which would provide an equivalent background.  

Preferred Skills, Capabilities and Qualifications: 

• For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• Due to the nature of the Behavioral Health Resource Center and Employee Assi