Health Insurance Specialist (Program Integrity)
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,Provider Compliance Group. As a Health Insurance Specialist (Program Integrity), GS-0107-13 you will review regulatory guidance and CMS program changes; developed reporting tools to analyze data, improve compliance and efficiency, support leadership decisions, and ensure alignment with federal requirements.
Major duties
Program Integrity Development and Implementation analyze, develop, and implement a wide range of program integrity initiatives that support CMS' lines of business through comprehensive program integrity reviews. Analytical Research and Special Projects apply a wide range of analytical methods and techniques to assess and improve program efficiency, effectiveness, and complex processes or systems relating to health programs. Legislative and Regulatory Analysis Evaluate and analyze the impact of new or revised changes to legislation before Congress pertaining to any CMS program. Stakeholder Engagement and Technical Assistance provide technical assistance to staff in other federal agencies, state agencies, and private sector organizations, consistent with program expertise and experience. Operational Requirements and Database Management produce routine and ad hoc reports, deliverables, and programmatic documentation to support program integrity operations.
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. Identifying health insurance program vulnerabilities to detect fraud, waste, or abuse; 2. Collaborating across organizational lines in support of program integrity educational efforts, or oversight of health insurance programs; AND 3. Developing and implementing policies for program integrity stakeholder and engagement activities. 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/13041015
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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