Administrative Officer II

State of Maryland•Baltimore City, MD

3d•Onsite

About The Position

The Maryland Health Benefit Exchange (MHBE) is seeking an Administrative Officer II, also known as an Escalated Case Resolution Coordinator. This role is crucial for administering Maryland Health Connection, the state's health insurance marketplace, under the Affordable Care Act (ACA). MHBE collaborates with various state departments and stakeholders to achieve its vision of high-quality, affordable health coverage for all Marylanders. The primary purpose of this position is to research and resolve escalated cases related to Medicaid, Qualified Health Plans (QHP), and Stand-Alone Dental Plans (SADP). The Coordinator will organize information, conduct consumer outreach, and perform informal case resolutions to ensure compliance with policies and regulations. This includes reviewing eligibility determinations for Insurance Affordability Programs such as Medicaid, Advanced Premium Tax Credits (APTC), Cost-Sharing Reductions (CSR), and Special Enrollment Periods (SEPs). The position requires subject matter expertise in Medicaid, private health coverage, the ACA, and internal systems like HBX, MMIS, E&E, and Salesforce. The role reports to the Deputy Director of Consumer Assistance and receives daily task assignments from the Carrier Case Resolution Lead Worker. Responsibilities extend to supporting Carrier Escalation Cases, Appeals and Grievances, and Constituent Services, with assignments varying in scope and potentially involving cross-functional collaboration and targeted outreach.

Requirements

Graduation from an accredited high school or possession of a high school equivalency certificate.
Two years of administrative staff or professional work.
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.

Nice To Haves

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.

Responsibilities

Reviews inbound escalations, determines appropriate next actions, and/or performs required corrections.
Communicates trends and issues in escalated cases to the Manager of Escalations.
Performs consumer outreach by phone, email, or secure messaging.
Corrects or verifies enrollment configurations and eligibility data in HBX.
Updates case statuses and maintains clear documentation of actions.
Adds appropriate cases to internal Trackers and coordinates resolution follow-up.
Generates and submits manual CTADs and 834 transactions when needed.
Manages assigned tasks daily 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.