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ADMINISTRATIVE OFFICER III

Escalations Coordinator Lead

Recruitment #25-002247-0034

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Introduction

MHBE is accepting applications for a vacant Escalations Coordinator Lead position! 

The Maryland Health Benefit Exchange (MHBE) is responsible for the administration of Maryland Health Connection, the State's health insurance marketplace, under the Patient Protection and Affordable Care Action of 2010 (ACA). MHBE works with the Maryland Department of Health, the Maryland Insurance Administration, the Department of Human Services, and stakeholders statewide.

MHBE Vision Statement: 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 For more information on MBHE please visit our website.

GRADE

15

LOCATION OF POSITION

MHBE is adhering to a hybrid work schedule. Work for this position will be completed at a remote location of your choice (3 days) and at our office located at 750 E. Pratt St, 6th Floor, Baltimore, MD 21202 (2 days).

Main Purpose of Job

The main purpose of this position is to provide support to the Exchange by researching escalatedcases, organizing information for review, performing informal resolution for the escalated case as wellas outreach to the impacted consumer(s) as needed, accurate reporting and appropriate outcomes. Theposition reviews eligibility for Insurance Affordability Programs (both Medicaid and Federal subsidies,including special enrollment periods) and ensures all resolutions are accurate and abide by currentpolicy and regulation. This position acts as a Subject Matter Expert (SME) for Medicaid, private healthplans, the Affordable Care Act, and internal systems (HBX, MMIS, E&E, SalesForce). The position willassist the Special Projects Manager with monitoring the MHBE SalesForce queues necessary andassign/review work items to the Special Project Coordinators.

POSITION DUTIES

Escalated Case Assignments:

  • Monitor individual queues in SalesForce for case assignment of escalated cases (MHBE CRM Escalations, MHBE Undefined Cases, MHBE CRM CSR, MHBE CRM Email Cases, cases assigned to individual SalesForce inboxes).
  • Receive and perform initial examination of escalated case, working towards resolution of issue/complaint within policy and federal guidelines.
  • Perform consumer outreach as needed, within scope of escalated case resolution.
  • Properly document case resolution in SalesForce incident, including summaries of actions taken as well as data sources used for determining resolution.
  • Proper and correct forwarding of case assignment to other departments (such as MHBE IT, MHBE EDI, MHBE Team, MDH EDD VCL Verification, MDH CRM
  • Retro Medicaid Requests) for continued work on the case and resolution.
  • Responding to and taking actions as appropriate on cases deemed as high priority referred to Escalated Case Resolution for further investigation/resolution.
  • Ensure cases are resolved accurately and properly closed in Salesforce utilizing current taxonomy guidelines.
  • Monitor and reply to social media contact on the social media platforms maintained by the Exchange (Facebook direct inbox messages, X, Instagram, WhatsApp)
  • Address and resolve any consumer concerns/questions in a professional and appropriate manner.
  • Assist the Escalated Case Resolution Manager by assigning cases via SalesForce to the Escalated Case Resolution Coordinators as needed.
  • Assist the Escalated Case Resolution Manager by reviewing cases currently being worked by or completed by the Escalated Case Resolution Coordinators as needed.
  • Assists the Escalated Case Resolution Manager by completing cases/tasks normally completed by the Escalated Case Resolution Manager as needed.
  • Assist with and answer any questions/concerns the Escalated Case Resolution Coordinators may have regarding their cases or assigned duties.
  • Performs other duties as required and/or assigned by the Escalated Case Resolution Manager, Deputy Director, or Director of Consumer Assistance.

MINIMUM QUALIFICATIONS

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

Experience: Three years of administrative staff or professional work.

Notes:

1. Candidates may substitute 30 college credit hours from an accredited college or university for each year up to two years 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 the 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

  • Knowledge of and experience with Medicaid eligibility
  • Knowledge of and experience with Qualified Health Plans 
  • Extensive customer service experience

LIMITATIONS ON SELECTION

MHBE Contractual Employees Only

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 operator’s license valid in the State of Maryland.

SELECTION PROCESS

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.

EXAMINATION PROCESS

The assessment may consist of a rating of your education, training, and experience related to the requirements of the position. It is important that you provide complete and accurate information on your application. Please report all experience and education that is related to this position.

BENEFITS

FURTHER INSTRUCTIONS

The online application process is STRONGLY preferred. If you are unable to apply online, you may submit a paper application: via email: tisha.payne@maryland.gov via mail: MHBE Office of Human Resources 750 E. Pratt St, 6th Floor Baltimore, MD 21202 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 your 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 I-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 I-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 (DHS) or Social Security Administration (SSA) so you can begin to resolve the issues before the employer can take any employment action against you.



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