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Appeals & Grievances Administrator

Recruitment #20-002586-0043




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

The candidate hired for this position will work remotely while State offices remain in Elevated Level II - Flexible Operations due to the COVID-19 pandemic.

Main Purpose of Job

The main purpose of this position is to provide support to the Appeals and Grievances Manager by researching grievance and appeals histories, organizing information for review, preparing summaries for hearings and presenting to A&G leadership to ensure timely decision making, accurate reporting and appropriate outcomes. The position reviews Medicaid eligibility, individual market eligibility appeals, mandate exemption appeals, employer eligibility appeals from the individual market, Maryland Health Connection for Small Business employer and employee eligibility appeals, as well as appeals of enrollment periods, including special enrollment periods. This position acts as a policy specialist for Medicaid and the Affordable Care Act, and assists with trainings for other departments within Maryland State agencies. This position will prepare IRS Tax Subsidy summaries for the Assisted Attorney General’s offices for the Maryland Health Benefit Exchange, and will testify as an expert witness during the administrative hearing process.  


Conduct research and adjudicate a caseload of appeals of individuals, business and/or providers. Interview applicants and representatives associated with investigation.

Analyze pertinent facts against appropriate regulatory and policy provisions and develop written recommendations to management for the appeal decision.

Develop the supporting case file, in consultation with legal staff, for appeals that escalate to a review by an Administrative Law Judge from the Office of Administrative Hearings. Provide support for adjudication of appeals and hearings as required.

Prepare written reports analyzing alternatives and consequences, specifying findings and recommendations for management action, strategy, policy determinations and process changes.

Provide extensive interpretation of state and federal eligibility statutes, regulations, policies and guidelines to the administrative vendor, enrolled subscribers and the general public.

Conduct review of eligibility appeal requests and supporting documentation, coordinate data collection with appellants perform general case management.


Education: A Bachelor's degree from an accredited college or university.

Experience: Four years of related experience in administrative staff or professional work.


1. Additional experience in administrative staff or professional work may be substituted on a year-for-year basis for the required education.

2. Additional graduate level education at an accredited college or university may be substituted at the rate of 30 semester credit hours on a year-for-year basis for the required experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer involving staff work related to the administration of rules, regulations, policy, procedures and processes, or overseeing or coordinating unit operations or functioning as a staff assistant to a higher ranking commissioned officer on a year-for-year basis for the required education and experience.


Preferred Qualifications:

Two years experience specializing in Appeals & Grievances Hearing process.

Extensive knowledge of the Affordable Care Act and Medicaid.

Must be able to travel to and attend hearings in all 24 counties within the State of Maryland. 


Employees in this classification will be assigned duties that 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. 


Applicants who meet the minimum and selective qualifications will be included in further evaluation. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment and may be requested prior to interview. Successful candidates will be ranked as Best Qualified, Better Qualified, or Qualified and will remain on the certified eligible list for a period of 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 tocomplete a supplemental question. Therefore, it is important that you provide complete and accurate information on your application. For education obtained outside the U.S., a copy of the equivalent American education as determined by a foreign credential evaluation service will be required before the time of hire.



The online application process is STRONGLY preferred. If you are unable to apply online, you may submit a paper application and resume to:


Maryland Health Benefit Exchange

Attn: Office of Human Resources or


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.


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.


Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service at, 1-800-735-2258.


This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm 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 I-9. If E-Verify is unable to confirm your authorization to work, this employer is required to give you written instructions, and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) to resolve the issue before the employer can take any employment action against you.