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ADMINISTRATIVE OFFICER II

Escalations Coordinator

Recruitment #25-003235-0029

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Introduction

MHBE is accepting applications for vacant Escalations Coordinator positions!

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

MHBE Vision Statement: High-quality, affordable health coverage for all Marylanders. MissionStatement: 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

14

LOCATION OF POSITION

MHBE is adhering to a hybrid work schedule. Work for this position will be completed at a remotelocation of your choice (3 days) and at our office located at 750 E. Pratt St, 6th Floor, Baltimore, MD21202 (2 days).

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 Programs—including Medicaid, Advanced Premium Tax Credits (APTC), Cost-Sharing Reductions (CSR), and Special Enrollment Periods (SEPs)—and ensures that all resolutions align with applicable federal and state guidelines.

POSITION DUTIES

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

Experience: Two years of administrative staff or professional work.

Notes:

  • Candidates may substitute 30 credit hours from an accredited college or university for one year of the required experience.
  • Candidates may substitute the possession of a Bachelor's degree from a college or university for the required experience.
  • 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

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

LIMITATIONS ON SELECTION

MHBE Contractuals Employee 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: joshua.powell@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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