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 Consumer Information and Insurance Oversight (CCIIO), Front Office. As a Health Insurance Specialist, GS-0107-14, you will serve as a Health Insurance Specialist and the Operations Lead responsible for designing, governing, and continuously improving the operational infrastructure that enables investigation, and remediation of fraud, waste, and abuse.
Major duties
Design, establish, and continuously refine the Center’s operational infrastructure to identify, track, and remediate complex fraud, waste, and abuse within the Health Insurance Marketplace. Develop risk-based operational strategies designed to strengthen program safeguards and mitigate fraud risks across the Marketplace program. Direct Center-level governance of fraud, waste, and abuse operations, designing and maintaining the cross-group processes by which MPMG, MEEG, MITG, and PPFMG coordinate their respective roles. Lead Center-level strategic planning initiatives designed to enhance the effectiveness, resilience, and long-term sustainability of fraud prevention, remediation, and enforcement operations supporting Marketplace program integrity. Serve as the principal liaison and authoritative advisor to senior leadership on complex fraud, waste, and abuse issues affecting the Health Insurance Marketplace.
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-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. Designing and maintaining operational systems and analytical frameworks to identify, monitor, and remediate fraud, waste, and abuse within federal health insurance programs or marketplaces, AND; 2. Directing and managing center-level governance processes for fraud oversight across multiple organizational groups or divisions, AND; 3. Leading long-range strategic planning initiatives focused on fraud prevention and program integrity within federal health insurance programs, AND; 4. Serving as a principal liaison to senior leadership and executive stakeholders on complex health insurance fraud and program integrity 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/13025148
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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