Health Insurance Specialist
What you'd do
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI). As a Health Insurance Specialist, GS-0107-13, you will analyze, develop, and implement integrity initiatives that support CMS' lines of business (e.g. Medicare, Medicaid and Children's Health Insurance Program (CHIP), Marketplace Exchange/Private Health Insurance, and Providers) through comprehensive program integrity reviews.
Major duties
Analyze, develop and implement program integrity initiatives across Medicare and Medicaid 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.
What you need to qualify
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 , 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) Advising stakeholders on Medicare or Medicaid provider payment suspension and revocation processes, policies, or regulations. (2) Collaborating across organizational lines on program integrity initiative or projects; and 3) Drafting, reviewing, or coordinating written responses to congressional inquiries, attorney correspondence, or other high-profile stakeholder communications. 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/12995236
Before you apply
Federal applications are different: your resume should be 3–5 pages and mirror the language of this announcement. Read our federal resume guide first — it's the #1 reason qualified people get screened out.
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