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.

As a Health Insurance Specialist, GS-0107-15, you will serve as a Senior Technical Advisor in the Audits and Vulnerabilities Group (AVG), Center for Program Integrity (CPI), Centers for Medicare & Medicaid Services (CMS).

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF 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-15, 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-14 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Planning projects to safeguard Medicare, Medicaid, or Marketplace from fraud, waste, or abuse; (2) Coordinating multi-stakeholder initiatives to achieve strategic program objectives related to Medicare, Medicaid, or Marketplace; AND (3) Delivering briefings, proposals or decision memoranda and making recommendations to Senior Executive Service members or political appointees on Medicare, Medicaid, or Marketplace issues.

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.

Time-in-Grade: To be eligible, current Federal employees must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/12895544 Major Duties:

• Resolve emerging complex issues, advising leadership of potential and emerging problem areas, including the formulation of recommendations for appropriate program responses.
• Act as the technical lead over Marketplace administrative actions, with the goal of developing and maintaining a robust oversight strategy that takes administrative action against problematic agents and brokers.
• Serve as a key Agency representative and expert on the CMS PI issues in meetings with federal and state government officials, staff, and other internal and external stakeholders.
• Administers an extremely complex, interrelated portfolio of PI vulnerabilities, all with the common goal of reducing and preventing fraud, waste, and abuse in the Marketplace and Medicaid.
• Apply extensive technical knowledge of the broad guidelines governing Federal health care, including laws and regulations applying to all federal health programs administered by CMS.