ADMINISTRATIVE OFFICER II (Escalated Case Resolution Coordinator)

Introduction

MHBE is accepting applications for an Admin Officer II/Escalated Case Resolution Coordinator.

The Maryland Health Benefit Exchange is responsible for the administration of Maryland Health Connection, the State''s health insurance marketplace, under the Patient Protection and Affordable Care Act of 2010 (ACA).

MHBE works with the Maryland Department of Health, Maryland Insurance Administration, Department of Human Services, and stakeholders statewide.

Our Vision: High-quality, affordable health coverage for all Marylanders.

Mission Statement: We improve the health and well-being of Marylanders by connecting them with high-quality, affordable health coverage through innovation, technology, and customer service.

Values: Diverse & Inclusive, Innovative, Collaborative, Ethical

GRADE

14

LOCATION OF POSITION

Baltimore City, Maryland

Main Purpose of Job

The main purpose of this position is to provide support to the Maryland Health Benefit Exchange (MHBE) by researching and resolving escalated cases involving Medicaid, Qualified Health Plans (QHP), and Stand-Alone Dental Plans (SADP).

The Escalated Case Resolution Coordinator organizes information for review, conducts outreach to impacted consumers, and performs informal case resolution to ensure accurate outcomes that comply with current policy and regulation. The position reviews eligibility determinations for Insurance Affordability Programsâincluding Medicaid, Advanced Premium Tax Credits (APTC), Cost-Sharing Reductions (CSR), and Special Enrollment Periods (SEPs)âand ensures that all resolutions align with applicable federal and state guidelines.

This position serves as a Subject Matter Expert (SME) in Medicaid, private health coverage, the Affordable Care Act, and internal systems including HBX, MMIS, E&E, and Salesforce. The Coordinator receives direction from the Deputy Director of Consumer Assistance and day-to-day task assignments from the Carrier Case Resolution Lead Worker. In addition to case-specific work, the Coordinator supports the ongoing operations of the Consumer Assistance Division.

Tasks may include support for Carrier Escalation Cases, Appeals and Grievances, and Constituent Services. Assignments vary in scope and may involve cross-functional collaboration, targeted outreach initiatives, and other duties as directed by the Director or Deputy Director of Consumer Assistance.

POSITION DUTIES

75% - Escalated Case Assignments

• Reviews inbound escalations, determines appropriate next actions, and/or performs required corrections. Communicates trends and issues in escalated cases to the Manager of Escalations. Actions may include:
• Performing consumer outreach by phone, email, or secure messaging
• Correcting or verifying enrollment configurations and eligibility data in HBX
• Updating case statuses and maintaining clear documentation of actions
• Adding appropriate cases to internal Trackers and coordinating resolution follow-up
• Generating and submitting manual CTADs and 834 transactions when needed
• Daily case management of assigned tasks from various Salesforce queues
• Utilizes subject matter expertise in Medicaid, QHP, eligibility rules, and enrollment policy to apply accurate resolutions based on current federal and state regulations.
• Refers cases to other departments when appropriate (e.g., MHBE IT, EDI, MDH CRM Retro Team,) for further research or resolution, following all documentation and taxonomy standards.
• Responds professionally and appropriately to consumer inquiries related to escalated case issues and communicates outcomes in a clear, respectful manner.

20%- Communication and Reporting

• Ensures case outcomes are properly narrated, resolved, and closed in Salesforce using the appropriate taxonomy classification and resolution codes.
• Contributes suggestions to enhance agency systems and operations based on insights gathered from consumer feedback, technical issues, and recurring case patterns.

5%- Other Duties as Assigned

• Performs other duties as required and/or assigned by the Carrier Case Resolution Lead Worker, Program Manager, Deputy Director, or Director of Consumer Assistance.

MINIMUM QUALIFICATIONS

Education:Â Â Â Graduation from an accredited high school or possession of a high school equivalency certificate.

Experience: Two years of administrative staff or professional work.

Notes:

1. Candidates may substitute 30 credit hours from an accredited college or university for one year of the required experience.

2. Candidates may substitute the possession of a Bachelor''s degree from a college or university for the required experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer involving staff work that included regular use of independent judgment and analysis in applying and interpreting complex administrative plans, policies, rules or regulations or analysis of operational programs or procedures with recommendations for improvement on a year-for-year basis for the required experience.

DESIRED OR PREFERRED QUALIFICATIONS

Preferred Qualifications

• 2 years of experience resolving health insurance carrier enrollment issues, including researching enrollment discrepancies, coordinating with insurance carriers, and facilitating accurate enrollment transactions.
• 2-years of experience working with Affordable Care Act (ACA) health insurance programs, including Qualified Health Plans (QHP), Medicaid, Advanced Premium Tax Credits (APTC), Cost-Sharing Reductions (CSR), or Special Enrollment Periods (SEP) applying federal or state eligibility regulations.
• 2 years of experience using a health insurance eligibility or enrollment system to research, document, and resolve complex consumer cases.

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operatorâs license valid in the State of Maryland.

SELECTION PROCESS

The online application process is STRONGLY preferred. If you are unable to apply online, you may mail a paper application and supplemental questionnaire to: 750 East Pratt Street, 6th Floor, Baltimore MD, 21202.

Applicants must meet all minimum (and selective) qualifications to be considered, and to appear on the list of people eligible for hire. Please read all requirements before applying.

Please make sure that you provide sufficient information on your application to show that you meet the qualifications for this recruitment. All information concerning your qualifications must be submitted by the closing date. We will not consider information submitted after this date. Successful candidates will be ranked as Best Qualified, Better Qualified, or Qualified and placed on the eligible (employment) list for at least one year.

The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

STATE OF MARYLAND BENEFITS

FURTHER INSTRUCTIONS

Resumes will not be accepted in lieu of completing the online or paper application.

Applications must be received no later than the close of business on the closing date.

As an equal opportunity employer, Maryland is committed to recruiting, retaining, and promoting employees who are reflective of the State''s diversity.

People with disabilities and bilingual candidates are encouraged to apply.

We thank you our veterans for their service to our country and encourage them to apply.

Appropriate accommodations for individuals with disabilities are available upon request by calling MD TTY Relay Service.

This employer participates in E-Verify and will provide the Federal government with your Form 1-9 information to confirm that you are authorized to work in the U.S.

Employers can only use E-Verify once you have accepted a job offer and completed the Form 1-9.

If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact the Department of Homeland Security (OHS) or Social Security Administration (SSA) so you can begin to resolve the issues before the employer can take any employment action against you.

For education obtained outside the U.S., a copy of the equivalent American education as determined by a foreign credential evaluation service must be provided prior to hire.

For questions regarding this recruitment, please contact the DBM Recruitment and Examination Division at Application.Help@maryland.gov or 410-767-4850, MD TTY Relay Service 1-800-735-2258.