Marketplace Domain Subject Matter Expert (SME)

Marketplace Domain Expertise and Advisory

• Serve as the MSD team's primary subject matter authority on ACA/Patient Protection and ACA (PPACA) policy, regulation, and CCIIO program operations

• Monitor and interpret annual Notice of Benefit and Payment Parameters (NBPP), plan year guidance, and CCIIO policy updates; brief operations staff on changes affecting MSD scope

• Provide expert guidance on QHP certification cycle requirements, issuer obligations, and CMS-issuer relationship management

• Support Tier 2 and Tier 3 escalation resolution for complex policy, regulatory, and plan management inquiries

Knowledge Management

• Lead development and maintenance of the MSD knowledge base, ensuring accuracy and currency of articles and related materials

• Author and review Tier 1–3 resolution guides, Standard Operating Procedures (SOP), and escalation playbooks for Marketplace-specific issue categories

• Ensure knowledge base content reflects current plan year policies, system changes, and issuer/agent-broker guidance

• Coordinate with AI/automation tools team to ensure triage bots and self-service content accurately reflect current Marketplace guidance

Training and Staff Development

• Design and deliver Marketplace domain training and mentorship for MSD Customer Service Representatives and Senior Analysts onboarding and annually for plan year refreshers and surge-readiness training materials

Stakeholder and Account Management Support

• Support Account Manager in issuer communications, onboarding, and annual QHP certification cycle outreach

• Contribute domain expertise to CMS-facing deliverables including monthly reports, escalation summaries, and continuous improvement recommendations

• Assist in preparing CMS briefings on Marketplace issue trends, emerging policy questions, and stakeholder feedback patterns

Experience

• Minimum 5 years of direct experience supporting CMS CCIIO Marketplace operations, QHP certification, issuer relations, or ACA plan management

• Direct experience on the CMS Marketplace Service Desk (MSD) or a closely adjacent CCIIO program

• Demonstrated expertise in QHP certification processes, including HIOS/MPMS submission workflows, plan management requirements, and issuer compliance obligations

• Experience developing or maintaining knowledge management content, SOPs, or training materials in a federal help desk or program support environment

• Excellent written and verbal communication skills; experience preparing federal deliverables, briefings, or policy documents

Technical Knowledge

• In-depth knowledge of HIOS (Health Insurance Oversight System), MPMS (Marketplace Plan Management System), and/or SERFF as used in the QHP certification process

• Familiarity with CMS Marketplace Quality Initiatives: Quality Rating System (QRS), QHP Enrollee Survey, and Quality Improvement Strategy (QIS)

• Working knowledge of ACA/PPACA statute, associated federal regulations, and annual CCIIO guidance documents

• Understanding of CCIIO stakeholder ecosystem

Preferred Qualifications

• Prior key personnel designation on a CMS or federal health IT service desk contract

• Experience with ITSM platforms (ServiceNow or equivalent) in a federal service desk environment

• Experience with AI-assisted knowledge management tools or chatbot/virtual agent content development

• Established relationships within the CCIIO/Marketplace contractor or federal program community

• Remote / Telework with occasional work at CMS CCIIO (Baltimore, MD)

• Ability to work Eastern Time Zone hours, including flexible scheduling during open enrollment surge periods (October–January)

• Potential travelfor meetings to locations throughout Baltimore, MD and/or Washington, DC areas