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Business Operations Specialist

Recruitment #18-003235-0023




750 E. Pratt Street, 6th Floor Baltimore, MD  21202 

Main Purpose of Job

The Escalation Team is responsible for investigating and resolving MHBE consumer-related issues. The Business Operations Specialist in the Case and Carrier Resolution Unit is responsible for coordination and implementation of swift, accurate resolution of a wide range of issue types. The team member must apply policy appropriately as directed, be comfortable in a technical environment, adjust to fluctuating inventory, manage time sensitive requests, pay close attention to detail, and have exceptional communication skills. This position requires collaborative problem solving while interfacing with consumers, technical teams, constituent services, appeals & grievances, producer operations, call center staff, QHP Carrier partners and Medicaid agency stakeholders.


Escalation Resolution

 Maintain Qualified Health Plan and guide Medicaid case inventory, ensuring efficient movement of complex issues.

 Collaboratively negotiate issue resolution with multiple internal and external stakeholders.  Serve as a Subject Matter Expert, researching complex case narratives and coordinating efficient resolution.

 Monitors escalation inventory in all queues for trends in type, aging and/or volume, raising issues for deeper investigation and/or bulk technical solutions as appropriate.

Communication / Reporting

 Prepares written communication as necessary to respond to case and carrier resolution inconsistencies

 Regularly supports high-intensity case resolution conference calls with Qualified Health Plan carrier partners.

Program Policy

    ·  Utilizing knowledge gained through handling escalated cases and feedback from consumers and stakeholder, suggest and promote agency wide policy, standards and workflow procedures to eliminate issues and enhance agency systems and operations.

   ·  Interprets and applies or oversees the application of agency policies, rules and regulations to accomplish unit work.


Education: Possession of a Bachelor's degree from an accredited four-year college or university.

Experience: Two years experience in administrative or professional work.


1. Candidates may substitute additional experience in administrative staff or professional work on a year-for-year basis for the required education.

2. Candidates may substitute additional graduate level education at an accredited college or university at the rate of 30 semester credit hours for each year of the required experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned or non-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 education and experience.


1. Experience with Maryland Health Connection enrollment process and eligibility determination or 834/8001 processing.

2. Prior experience as a lead worker, subject matter expert, and/or quality assurance specialist.

3. Experience prioritizing multiple tasks in a fast paced environment.

4. Excellent communication skills, teamwork, and the ability to form partnerships with diverse stakeholders.


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 employment (eligible) list for at least one year.


The examination will consist of a rating of your education, training, and experience as presented on your application and as they relate to the requirements of the position.  You may be required to complete a supplemental question.  Therefore, it is important that you provide complete and accurate information on your application



Resumes will not be accepted in lieu of the online or paper application process.

The online application process is STRONGLY preferred, you are unable to apply online, you may complete and submit a completed paper application to:

Shadrick Phillips   email;

Human Resources

Maryland Health Benefit Exchange

750 East Pratt St.6th Floor Baltimore, Maryland 21202

TTY Users: call via Maryland Relay at 1-800-735-2258

We thank our Veterans for their service to our country, and encourage them to apply.

As an equal opportunity employer Maryland is committed to recruiting, retaining and promoting employees who are reflective of the State’s diversity.