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Administrator, Carrier Resolutions

Recruitment #22-002586-0007


MHBE is accepting applications for a vacant Administrator, Carrier Resolutions position! 

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.

Vision Statement: 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.

For more information on MHBE, please visit our website.




MHBE is adhering to a hybrid work schedule. Work for this position will be completed at a remote location of your choice (3 days) and at our office located at 750. E. Pratt St, 6th Floor, Baltimore, MD 21202 (2 days).


The Carrier Resolutions Unit is responsible for investigating and resolving MHBE application and enrollment related issues. This highly skilled unit interfaces with technical teams, constituent services, appeals, producer operations, call center, and carrier partners to resolve consumer enrollments issues escalated for evaluation. The Carrier Resolution Administrator is responsible for overseeing multi-team workflows to ensure timely and professional resolution to consumer technical and operational issues. The Administrator implements and coordinates the interpretation and application of the carrier resolution unit t directives and procedures.

Operational Oversight
  • Leverages Excel and Google sheets to monitor type, referral source, and volume of QHP escalations, assign work to MHBE internal resources and Maximus contractual staff, ensuring cases tracked, investigated, and responded to in a timely fashion.
  • Coordinates with Special Projects supervisor regarding case trending, adjusts workload according to global volume, and assigns tasks to Special Projects SME staff.
  • Coordinates with Special Projects Supervisor to mentor and train Special Projects SME staff, preparing them to handle direct interaction with the QHP Carriers, perform complex analysis, and expedite urgent concerns.
  • Evaluates efficiency of operations and develops, revises, and recommends new policies, standards, and workflow procedures for Escalation’s resolution.
  • Monitors Escalations volume, age, and type, overseeing Escalation’s workflow to effectively sustain volume and minimize aging of escalated cases.
  • Coordinates workflow with other units (IT, producer operations, call center special projects, plan services, appeals/constituent services, eligibility, and business integration) to facilitate issue resolution.
  • Monitor JIRA tickets for upgrade requirements to SalesForce systems/programs to streamline escalations case files between Insurance Carriers and the Maryland Health. 

  • Escalation Resolution
  • Serves as a POC for MDH, Connector Entity, Producer Operations, and Call Center staff to emergently negotiate access to coverage for escalations with pressing medical need.
  • Serves as a POC for MDH, Connector Entity, Producer Operations, and Call Center staff to coordinate review and resolution of aged or complex issues that remain unresolved as per standard triage.  Refers cases requiring aged research or policy decisions to appropriate Appeals/Constituent Services and/or Policy stakeholders.
  • Acts as liaison between IT and Operations to coordinate bulk resolution opportunities, identify system-related issues/enhancements, and coordinate smooth work management across multiple specialties.

  • Reconciliation Support
  • Discrepancy trending, report issues, and data reconciliation. 
  • Advises and supports MHBE IT/EDI staff as needed regarding business process agreements and discrepancy resolution strategies.
  • Referring to tracker process as needed.
  • Manages Complex Case trackers, coordinating case resolution requiring outreach, 834 corrections, HBX Application updates, and/or IT corrections. 

  • Communication / Reporting
    KP Escalations: 2x/week CF Escalations: 2x/week Leads and organizes MHBE and Carrier meetings regarding collaborative resolution of QHP Complex Enrollment issues. Coordinates close partnerships between Maryland Health Benefits exchange and IT contractor’s staff to investigate and resolve Escalated technical case errors. 

    Program Policy
    Utilizing knowledge gained through handling escalated cases and feedback from consumers and stakeholder, suggests and promotes policy, standards and workflow procedures to eliminate escalated case issues and enhance agency systems and operations. Interprets and applies or oversees the application of agency policies, rules and regulations on escalated cases to accomplish unit work.

    Assigns work and trains staff.


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


    1. Candidates may substitute 30 college credit hours from an accredited college or university for each year up to four years of the required experience. 

    2. Candidates may substitute the possession of a Bachelor's degree from an accredited college or university and four years of experience in administrative staff or professional work for the required experience.

    3. Candidates may substitute additional graduate level education at an accredited college or university at the rate of 30 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 experience.


    This position is open to current MHBE employees only. 


    Working knowledge of laws and regulations related to Medicaid eligibility

    Working knowledge of laws and regulations related to Qualified Health Plans

    Proficient working knowledge of HBX configurations

    Extensive experience in carrier resolution experience

    Extensive customer service experience


    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 eligible (employment) list for at least one year.


    The assessment may consist of a rating of your education, training, and experience related to the requirements of the position. It is important that you provide complete and accurate information on your application. Please report all experience and education that is related to this position.



    The online application process is STRONGLY preferred. If you are unable to apply online, you may submit a paper application and resume:
    via email: 
    via mail: MHBE Office of Human Resources 
    750 E. Pratt St, 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. 

    Appropriate accommodations for individuals with disabilities are available upon request by calling MDTTY Relay Service. TTY Users: call via Maryland Relay. 

    As an equal opportunity employer, Maryland is committed to recruiting, retaining, and promoting employees who are reflective of the State's diversity. People with disabilities and bilingual candidates are encouraged to apply.  
    We thank your Veterans for their service to our country and encourage them to apply. 

    This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that 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 cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact the Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issues before the employer can take any employment action against you.

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