MANAGER, APPEALS AND GRIEVANCES

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Maryland Health Benefit Exchange, Baltimore, MD

The Manager of Appeals and Grievances is responsible for developing, implementing and administering the case management system for eligibility grievances and appeals. The position has general oversight responsibilities for the Exchange appeals and grievances process, which includes internal reviews, informal appeals/reconsiderations and contested case hearings.  The position will assist in implementing regulations, policies and measures; tracking appeals; identifying appropriate modifications to processes and developing required reports.  The position oversees the review of individual market eligibility appeals, navigator appeals, authorized producer appeals, qualified plan appeals, Small Business Health Options Program (SHOP) employer eligibility appeals and SHOP employee eligibility appeals.

Education:  A Bachelor’s degree from an accredited college or university in Public Health, Public Policy, Healthcare Management or related area.

Experience:  Seven years of experience in medical care, health insurance, or federal or State entitlement programs eligibility or appeals case management, including four years of supervision.  Extensive knowledge of Medicaid and the Affordable Care Act. 

A master’s degree from an accredited college or university is preferred.

Applicants who meet the minimum qualifications will be evaluated.  The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position.  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.  For education obtained outside the U.S., a copy of the equivalent American education as determined by a foreign credential evaluation service must accompany the application.  All information concerning your qualifications must be submitted by the closing date.  We will not consider information submitted after this date.  Applicants certified to list will receive eligibility for a period of one (1) year.
Eligibility may be extended beyond one (1) year period.  For Recorded Job Information Call:  410-767-6018.

Online applications are highly recommended, however the paper application may be submitted to DHMH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201.  The paper application must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

Incorrect application forms will not be accepted.

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

STATE OF MARYLAND BENEFITS  

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

If you need to submit additional information, the preferred method is to upload.  If unable to upload, please fax requested information only to 410-333-5689.