Health Insurance Specialist (Medicare Administrative Contractor COR III)

Full Job Description

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare (CM), Medicare Contractor Management Group (MCMG), Western MAC Program Management Division (WMPMD).

As a Health Insurance Specialist (Medicare Administrative Contractor COR III), GS-0107-14, you will serve as a Contracting Officer's Representative (COR) for the needs and requirements for one or more assigned Medicare Administrative Contractors (MACs).

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-14, 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-13 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Administering health-related or insurance-related contracts; AND 2) Developing or evaluating Medicare policies or contracts; AND 3) Leading projects or teams related to contract administration.

You Must be able to obtain and maintain a COR III Certification.

(Note: Documentation demonstrating that you possess your COR III Professional must be uploaded at time of application) 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 or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year 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/12879356 Major Duties:

• Accountable for the successful performance of all functions detailed in the Statements of Work (SOW) for their assigned MACs and the oversight of contractor operations.
• Conduct periodic analysis of contractor’s performance and cost data to identify any systemic issues, trends, or concerns for discussion.
• Plan and develop the detailed specifications for the MACs, including the direction, operation, and implementation requirements.
• Perform analyses of operational policy and program operations to evaluate the appropriateness, cost effectiveness, or other impact resulting from the implementation of law, regulations, policy, or operational procedures and systems.
• Review deliverables and advises OAGM of the assigned MACs’ performance and advises them regarding contractors' compliance with technical and performance requirements.