Administrative Officer II; Escalated Case Resolution Coordinator

Introduction

MHBE is accepting applications for an 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

14

750 East Pratt Street, Baltimore Maryland, 21202

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. This position serves as a Subject Matter Expert (SME) in Medicaid, private health coverage, the Affordable Care Act, and internal systems including HBX, MMIS, E&E, and Salesforce.

The Coordinator receives direction from the Deputy Director of Consumer Assistance and day-to-day task assignments from the Carrier Case Resolution Lead Worker. In addition to case-specific work, the Coordinator supports the ongoing operations of the Consumer Assistance Division. Tasks may include support for Carrier Escalation Cases, Appeals and Grievances, and Constituent Services. Assignments vary in scope and may involve cross- functional collaboration, targeted outreach initiatives, and other duties as directed by the Director or Deputy Director of Consumer Assistance.

• 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, MDHCRM 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.

Education:

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

Exper…