Marketplace Domain Subject Matter Expert (SME)

Job Description

CWS is pursuing the CMS Marketplace Service Desk (MSD) opportunity. The MSD supports the Center for Consumer Information and Insurance Oversight (CCIIO) by providing technical assistance to issuers, agents and brokers, Application Development Organizations (ADOs), state agencies, and other Affordable Care Act (ACA) Marketplace stakeholders.

The Marketplace Domain SME is a key position responsible for providing deep subject matter expertise in the ACA Health Insurance Marketplace, Qualified Health Plan (QHP) certification, and CCIIO program operations. This individual will serve as the resident domain authority for our MSD team — ensuring service desk operations, knowledge management content, training curricula, and stakeholder communications reflect accurate, current Marketplace policy and regulatory knowledge.

Key Tasks & Responsibilities

Marketplace Domain Expertise and Advisory

Knowledge Management

Training and Staff Development

Stakeholder and Account Management Support

• 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
• 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
• 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
• 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

Experience

Technical Knowledge

Preferred Qualifications

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

Computer World Services is committed to the full inclusion of all qualified individuals.

• 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 travel for meetings to locations throughout Baltimore, MD and/or Washington, DC areas