Health Insurance Specialist

Full Job Description

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), Fraud Investigations Group (FCLH).

As a Health Insurance Specialist, GS-0107-13, you will analyze, develop, and implement a wide range of program integrity initiatives that support CMS' lines of business.

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.

Your resume (limited to no more than 2 pages) must include detailed information as it relates to the responsibilities and specialized experience for this position.

Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating.

This will prevent you from being considered further.

In order to qualify for the GS-13 grade level, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-12 grade level in the Federal government, obtained in either the private or public sector, to include: Develop, evaluate and implement program integrity policies; and Evaluating health insurance program vulnerabilities to detect, fraud, waste or abuse; and Collaborating across organizational lines on investigations, audits or oversight of health insurance programs.

Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional, philanthropic, religious, spiritual, community, student, social).

Volunteer work helps build critical competencies, knowledge, and skills, and can provide valuable training and experience that translates directly to paid employment.

You will receive credit for all qualifying experience, including volunteer experience.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/12936537 Major Duties:

• Analyze, develop and implement program integrity initiatives across Medicare, Medicaid, Children's Health Insurance Program (CHIP) and Marketplace programs.
• Review payments and investigate fraud, waste and abuse allegations.
• Serve as an expert on program integrity policies and provide guidelines to internal and external stakeholders.
• Collaborate across CMS and external partners on program integrity initiatives and projects.