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Health Insurance Specialist (Program Oversight)
Health Insurance Specialist (Program Oversight)-March 2024
Mar 30, 2026
About Health Insurance Specialist (Program Oversight)

Summary This position is located in the Department of Health Human Services (HHS), Centers for Medicare Medicaid Services (CMS), Office of Program Operations and Local Engagement (OPOLE), Division of Price Transparency Compliance. As a Health Insurance Specialist (Program Oversight), GS-0107-13, you will serve as an expert in the development, evaluation, and implementation of policies with the monitoring, oversight and payment models of external CMS stakeholders. Responsibilities Develop and review health care policies to draft related policy documents, regulations, procedures, and guidance. Conduct various reviews and studies to assess ongoing operations and program vulnerabilities. Respond to inquiries regarding program oversight activities and engage with internal and external stakeholders. Contribute to discussions and planning sessions on program oversight developments. Provide policy or technical direction to internal and external stakeholders. Requirements Conditions of Employment Qualifications ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT. Your resume 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 receiving further consideration. 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. Provide technical advice or policy guidance to health care providers or the general public regarding Medicare or other health care program laws and guidelines; AND 2. Analyze or interpret Medicare or other health care program policies and regulations in order to resolve issues and provide recommendations; AND 3. Examine performance through reviews or audits and document recommended plans of correction to address deficiencies or program vulnerabilities. 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/12640392 Education Additional Information Bargaining Unit Position: Yes- American Federation of Government Employees, Local 1923 Tour of Duty: Flexible Recruitment/Relocation Incentive: Not Authorized Financial Disclosure: Not Required Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement; however, CMS offers flexible working arrangements and allows employees the opportunity to participate in telework combined with alternative work schedules at the manager's discretion. This position may be authorized for telework. Telework eligibility will be discussed during the interview process. Supervisory positions must report a minimum 2 times per week and non-Supervisory positions must report a minimum of 2 times per pay period. For more information on locality and pay scales, please click here. The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at www.opm.gov/rif/employeeguides/careertransition.asp.

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