OHIM Carrier Relations and Enrollment Specialist

State of Maine • Portland, OR

8d • Hybrid

About The Position

Make an impact on access to health coverage in Maine. OHIM is seeking a detail-oriented and collaborative Carrier Relations and Enrollment Specialist to play a key role in ensuring accurate Marketplace eligibility determinations, seamless enrollments, and strong partnerships with health insurance carriers. In this role, you will serve as a critical liaison between the Marketplace and participating health insurance carriers. Key responsibilities include: Manage eligibility and enrollment casework, resolve escalated Marketplace applications and enrollments to ensure accurate consumer outcomes Support monthly carrier reconciliation processes, identifying, analyzing, and resolving enrollment discrepancies across systems Build and maintain strong carrier relationships, working directly with health insurance partners to troubleshoot issues and ensure alignment Analyze complex datasets to identify trends, inconsistencies, and opportunities for process improvement Support annual plan, benefit, and rate validation/testing in collaboration with carriers Participate in User Acceptance Testing (UAT) for system enhancements, defect resolution, and new functionality Serve as a key contributor to continuous improvement efforts across eligibility, enrollment, and carrier operations.

Requirements

• A Bachelor’s Degree in Public/Community Health, Health Administration, Health Sciences or Health Education; Public Administration, Government, Social Work, or a closely related field and three (3) years professional experience in the planning, development, coordination and/or evaluation of health programs or services -OR- an equivalent seven (7) year combination of education, training, and experience.

Nice To Haves

• Experience with carrier reconciliation, enrollment auditing, or resolving data discrepancies between systems and external partners
• Familiarity with insurance eligibility systems and processes, including eligibility rules, plan selection, and effectuated enrollment workflows
• Experience with eligibility and/or enrollment casework for federal, state, or health and human services programs (e.g., Medicaid, Health Insurance Marketplace, SNAP, TANF).

Responsibilities

• Manage eligibility and enrollment casework, resolve escalated Marketplace applications and enrollments to ensure accurate consumer outcomes
• Support monthly carrier reconciliation processes, identifying, analyzing, and resolving enrollment discrepancies across systems
• Build and maintain strong carrier relationships, working directly with health insurance partners to troubleshoot issues and ensure alignment
• Analyze complex datasets to identify trends, inconsistencies, and opportunities for process improvement
• Support annual plan, benefit, and rate validation/testing in collaboration with carriers
• Participate in User Acceptance Testing (UAT) for system enhancements, defect resolution, and new functionality
• Serve as a key contributor to continuous improvement efforts across eligibility, enrollment, and carrier operations.

Benefits

• Work-Life Fit – Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave.
• Health Insurance Coverage – The State of Maine pays 85%-100% of employee-only premiums ($12,845.82 - $15,112.76 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State.
• Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%. Visit the Office of Employee Health and Wellness for more information about program requirements.
• Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($395.72 annual value).
• Retirement Plan – The State contributes the equivalent of 14.11% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS).
• Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child—including non-birthing and adoptive parents—receive six weeks of fully paid parental leave.
• Additional, unpaid leave may also be available, under the Family and Medical Leave Act.
• State employees are eligible for an extensive and highly competitive benefits package, covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level