Maryland
ADMINISTRATIVE OFFICER II (Escalated Case Resolution Coordinator) - #25-003235-0
Maryland, Baltimore, Maryland, United States, 21276
Introduction
MHBE is accepting applications for a contractual 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 750 East Pratt Street, Baltimore Maryland, 21202
Main Purpose of Job The main purpose of this position is to provide support to the Exchange by researching escalated cases, organizing information for review, performing informal resolution for the escalated case as well as outreach to the impacted consumer(s) as needed, accurate reporting and appropriate outcomes. The position reviews eligibility for Insurance Affordability Programs (both Medicaid and Federal subsidies, including special enrollment periods) and ensures all resolutions are accurate and abide by current policy and regulation. This position acts as a Subject Matter Expert (SME) for Medicaid, private health plans, the Affordable Care Act, and internal systems (HBX, MMIS, E&E, SalesForce). Secondary tasks will be assigned to support the MHBE Consumer Assistance’s continued operations and coordination with other internal stakeholders/departments, such as Carrier Escalation Cases, Appeals and Grievances, and Constituent Services. The assigned tasks are as needed and vary in scope, such as outreach initiatives for consumer issues, case examination and resolution, and other tasks as assigned by the Director or Deputy Director of Consumer Assistance.
POSITION DUTIES
Escalated Case Assignments (85%)
– 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 Special Projects for further investigation/resolution. Ensure cases are resolved accurately and properly closed in Salesforce utilizing current taxonomy guidelines.
Communications (10%)
– 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.
Other Duties as Assigned (5%)
– Performs other duties as required and/or assigned by the 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:
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
Knowledge of and experience with Qualified Health Plans.
Strong written and verbal communication skills gained through five (5) or more years of customer service experience.
Proficiency in analyzing healthcare eligibility and enrollment issues.
Knowledge of and experience with Medicaid eligibility.
LIMITATIONS ON SELECTION Open to existing contractual workers of the Maryland Health Benefit Exchange 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 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. 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.
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 STATE OF MARYLAND BENEFITS
FURTHER INSTRUCTIONS The online application process is strongly preferred. If you are unable to apply online, you may submit a paper application: Email: mhbe.hr@maryland.gov or Mail: MHBE Office of Human Resources 750 E. Pratt Street, 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 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.
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GRADE 14
LOCATION OF POSITION 750 East Pratt Street, Baltimore Maryland, 21202
Main Purpose of Job The main purpose of this position is to provide support to the Exchange by researching escalated cases, organizing information for review, performing informal resolution for the escalated case as well as outreach to the impacted consumer(s) as needed, accurate reporting and appropriate outcomes. The position reviews eligibility for Insurance Affordability Programs (both Medicaid and Federal subsidies, including special enrollment periods) and ensures all resolutions are accurate and abide by current policy and regulation. This position acts as a Subject Matter Expert (SME) for Medicaid, private health plans, the Affordable Care Act, and internal systems (HBX, MMIS, E&E, SalesForce). Secondary tasks will be assigned to support the MHBE Consumer Assistance’s continued operations and coordination with other internal stakeholders/departments, such as Carrier Escalation Cases, Appeals and Grievances, and Constituent Services. The assigned tasks are as needed and vary in scope, such as outreach initiatives for consumer issues, case examination and resolution, and other tasks as assigned by the Director or Deputy Director of Consumer Assistance.
POSITION DUTIES
Escalated Case Assignments (85%)
– 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 Special Projects for further investigation/resolution. Ensure cases are resolved accurately and properly closed in Salesforce utilizing current taxonomy guidelines.
Communications (10%)
– 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.
Other Duties as Assigned (5%)
– Performs other duties as required and/or assigned by the 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:
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
Knowledge of and experience with Qualified Health Plans.
Strong written and verbal communication skills gained through five (5) or more years of customer service experience.
Proficiency in analyzing healthcare eligibility and enrollment issues.
Knowledge of and experience with Medicaid eligibility.
LIMITATIONS ON SELECTION Open to existing contractual workers of the Maryland Health Benefit Exchange 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 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. 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.
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 STATE OF MARYLAND BENEFITS
FURTHER INSTRUCTIONS The online application process is strongly preferred. If you are unable to apply online, you may submit a paper application: Email: mhbe.hr@maryland.gov or Mail: MHBE Office of Human Resources 750 E. Pratt Street, 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 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.
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