Health Insurance Specialist (Program Contractor Management)

Full Job Description

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation.

As a Health Insurance Specialist, referred here as a Health Insurance Specialist (Program Contractor Management), GS-0107-13, you will review/administer contracted stakeholders that participate in the agency health care delivery/quality/payment programs to ensure compliance with contractual requirements.

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-13 position, 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: 1.

Developing and implementing policies related to evaluating contractors who participate in agency health care delivery and quality or payment programs. 2.

Identifying and designing contract requirements during the planning and awarding phase of acquisitions to support model design and implementation. 3.

Analyzing performance against contract requirements and document performance with emphasis on significant trends to provide feedback to contractors and inform process improvement over the life of the contract.

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/12899624 Pay range for GS-13: Atlanta (ATL): $112,556-$146,325 Woodlawn (DCB): $121,785-$158,322 Philadelphia (PHI): $117,284-$152,471 Major Duties:

• Serve as an expert in the development, evaluation and implementation of policies related to administering, reviewing, and evaluating contracted stakeholders that participate in agency health care delivery and quality or payment programs.
• Identify and propose modifications to operations to reflect changes or trends in health care industry program objectives and needs of beneficiaries.
• Serve as an adhoc team/project leader or member involved in various activities to improve the efficiency and effectiveness of the division.
• Conduct and lead analytical studies and special projects by gathering, organizing, and interpreting policy, program and/or operational issues related to contractor management administration functions.