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Administrative Specialist II – Case & Carrier Resolution

Recruitment #24-003235-0023


MHBE is accepting applications for a vacant Administrative Specialist II – Case &Carrier Resolutions position 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 of2010(ACA). MHBE works with the Maryland Department of Health, Maryland Insurance Administration, Department of Human Services, and stakeholders statewide. Vision Statement : High-quality, affordable health coverage for all Marylanders. Mission Statement : We improve the health and well-being of Marylanders by connecting them withhigh-quality, affordable health coverage through innovation, technology, and customer service. Values : Diverse & Inclusive, Innovative, Collaborative, & Ethical. For more information on MHBE, please visit our website .




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

Main Purpose of Job

The Administrative Specialist II in the Case and Carrier Resolution Unit is responsible for coordination and implementation of swift and accurate resolution of a wide range of case issue types. At the direction of the Escalation Unit Manager, the Administrative Specialist II may collaborate with a diverse group of MHBE teams and external stakeholders including technical teams (MHBE IT and Data Specialists), Constituent Services, Appeals & Grievances, Producer Operations, Call Center Staff, QHP Carrier Partners, and Medicaid staff consisting of MHBE employees, consultants, and external stakeholders. The Administrative Specialist II must apply policies appropriately as directed, be comfortable in a highly technical environment working with large data sets, pay close attention to detail, and work well in a highly dynamic and time sensitive environment.


60% Escalation Resolution
Reviews inbound escalations, determines appropriate next actions, and/or performs required corrections. Communicates trending of inbound cases to Manager of Escalations & Special Projects. Actions may include Referral and perform consumer outreach, correcting enrollment configurations, escalating cases through Carrier Interchange Tool, adding case to Carrier Trackers, writing manual 834 files, Daily case management of assigned tasks. Maintain and guide case inventory, ensuring efficient movement of complex issues. Navigate and research resolutions for Retro Medicaid and Mixed Household escalations. Collaboratively negotiate issue resolution with multiple internal and external stakeholders. The ability to navigate and research complex case narratives and coordination of efficient resolutions. 

20% Communication and Reporting   
Prepares written communication as necessary to respond to case and carrier resolution inconsistencies Regularly supports high-intensity case resolution conference calls with QHP carrier partners, uses Google Sheets, Excel, and similar systems to track staff case assignment, reporting on workload and case origin per business owner (MHBE, Call Center, Carrier Issues). Uses pivot table or formulas in Excel to compile daily status reports regarding the number and type of case inconsistency issues. Provides feedback and collaborates regarding efficient resolution of technical, process, personnel driven issues in changing environment. Attends carrier resolution and work management meeting, as directed 

15%  Program Policy      
Leverage MHBE Policy and Procedures regarding eligibility, enrollment, dispute handling, documentation standards to resolve issues professionally and consistently Utilizing knowledge gained through handling escalated cases and feedback from consumers and stakeholders, contributes suggestions to standards and workflow procedures to eliminate issues and enhance agency systems and operations Applies the application of agency policies, rules and regulations to accomplish unit work, as directed  

5% Reporting   
Reviewing daily escalations reports and reporting aged cases for Appeals & Grievances, Constituent Services and Maximus cases.


Experience: Six years experience in administrative staff or professional work.

Notes: 1. Candidates may substitute 30 credit hours from an accredited college or university for each year forup to four years of the required experience. 2. Candidates may substitute the possession of a Bachelor's degree from a college or university andtwo years of experience in administrative staff or professional work for the required experience. 3. Candidates may substitute additional graduate level education at an accredited college or universityat the rate of 30 credit hours for each year of the required experience. 4. 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.


Demonstrated working knowledge of laws and regulations pertaining to Medicaid eligibility.
Proficiency in understanding and applying laws and regulations related to Qualified Health Plans (QHPs). 
Proficient working knowledge of HBX, MMIS or Salesforce. 
Extensive experience in customer service, with a proven track record of effectively resolving customer inquiries and issues.


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.


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 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.



Personal Leave - new State employees are awarded six (6) personnel days annually (prorated based on start date) Annual Leave - ten (10) days of accumulated annual leave per year
Sick Leave - fifteen (15) days of accumulated sick leave per year 
Parental Leave - up to sixty (60) days of paid parental leave upon the birth or adoption of a child 
Holidays - State employees also celebrate at least twelve (12) holidays per year Pension  
State employees earn credit towards a retirement pension 
401(k) – State employees can contribute to a supplemental Retirement Plan


The online application process is STRONGLY preferred. If you are unable to apply online, you may submit a paper application and resume: via email: 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. Appropriate accommodations for individuals with disabilities are available upon request by calling MDTTY Relay Service. TTY Users: call via Maryland Relay. 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. This employer participates in E-Verify and will provide the federal government with your Form I-9information 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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