Marketplace Domain Subject Matter Expert (SME)

Key Tasks & Responsibilities

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

Education & Experience

Education

Bachelor’s degree required in health policy, public administration, public health, business administration, information technology, or a related field

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

Certifications

PMP, ITIL Foundation, or equivalent project/service management certification preferred

Security Clearance

Must be able to obtain a federal Public Trust , Moderate Background Investigation (MBI ), or higher clearance

Other (Travel, Work Environment, DoD 8570 Requirements, Administrative Notes, etc.)

Remote / Telework with occasional work at CMS CCI IO (Baltimore, MD)

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

Potential travel for meetings to locat ions throughout Baltimore, MD and/ or Washington, DC area s