ADMINISTRATIVE OFFICER II
Case & Carrier Resolutions
Recruitment #22-003235-0057
Department | MD Health Benefit Exchange |
---|---|
Date Opened | 8/8/2022 12:50:00 PM |
Filing Deadline | 8/22/2022 11:59:00 PM |
Salary | $45,604.00 - $72,634.00/year |
Employment Type |
Full-Time
|
HR Analyst | JasCiel Stamp |
Work Location |
Baltimore City
|
Telework Eligible | Yes |
Introduction
GRADE
LOCATION OF POSITION
POSITION DUTIES
- Reviews inbound escalations, determines appropriate next actions, and/or performs required corrections. Communicates trending of inbound cases to Manager of Escalations & Special Projects. Actions may include: -Referral and perform consumer outreach -Correcting enrollment configurations on HBX -Escalating cases through Carrier Interchange Tool -Updating carrier case status -Adding case to Carrier Trackers -Writing manual 834 files -Research CareFirst Tiger Cases -Daily case management of assigned tasks
- Maintain QHP and guide Medicaid case inventory, ensuring efficient movement of complex issues
- Navigate and research resolutions for Retro Medicaid and Mixed Household escalations
- Collaboratively negotiate issue resolution with multiple internal and external stakeholders. Ability to navigate and research complex case narratives and coordination efficient resolutions.
- Prepares written communication as necessary to respond to case and carrier resolution inconsistencies
- Regularly supports high-intensity case resolution conference calls with QHP carrier partners
- As guided by Manager, uses Google Sheets, Excel, and similar systems to track staff case assignment, reporting on workload and case origin per business owner (MHBE, Call Center, Carrier Issues).
- As guided by Manager, uses pivot table or formulas in Excel to compile daily status reports regarding the number and type of case inconsistency issues
- As guided by Manager, leverages VLookup function in Excel to compare caseload lists for efficient determination of resolution actions
- Provides feedback and collaborates regarding efficient resolution of technical, process, personnel driven issues in changing environment
- Attends carrier resolution and work management meeting, as directed
- Leverage MHBE Policy and Procedures regarding eligibility, enrollment, dispute handling, documentation standards to professionally and consistently resolve issues
- Utilizing knowledge gained through handling escalated cases and feedback from consumers and stakeholders, contributes suggestions to standards and workflow procedures to eliminate issues and enhance agency systems and operations
- Applies the application of agency policies, rules and regulations to accomplish unit work, as directed
- Reviewing daily escalations reports and reporting aged cases for Appeals & Grievances, Constituent Services and Maximus cases.
MINIMUM QUALIFICATIONS
Experience: Six years experience in administrative staff or professional work.
Notes:
1. Candidates may substitute 30 credit hours from an accredited college or university for each year for up to four years of the required experience.
2. Candidates may substitute the possession of a Bachelor's degree from a college or university and two 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 for each year of the required experience.
4. Candidates may substitute U.S. Armed Forces military service experience as a 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 experience.
DESIRED OR PREFERRED QUALIFICATIONS
- 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 customer service experience
LICENSES, REGISTRATIONS AND CERTIFICATIONS
SELECTION PROCESS
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.
EXAMINATION PROCESS
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.
BENEFITS
As an employee of the State of Maryland, you will have access to outstanding benefits, including: health insurance, dental, and vision plans offered at a low cost. Click on this link for more details STATE OF MARYLAND BENEFITS
Personal Leave - new State employees are awarded six (6) personnel days annually (prorated based on start date) Annual Leave - ten (10) days of accumulated annual leave per year