Health Insurance Specialist

Summary This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicaid and CHIP Services(CMCS). As a Health Insurance Specialist, GS-0107-13, you will serve as an expert in the development, evaluation, and implementation of policies related to Medicaid, CHIP, and Basic Health Program (BHP) policies to support Fraud, Waste, and Abuse (FWA) and Working Families Tax Credit (WFTC) initiatives. Learn more about this agency Duties Identifies and proposes modifications to Medicaid, CHIP, and BHP program measures, regulations, laws, and policies to reflect changes or trends in the health care industry, program objectives, and the needs of Medicaid, CHIP, and BHP beneficiaries. Conducts analysis of policy issues and topics by researching background information, the origin of laws, and the intended impact to make effective policy recommendations. Evaluates and analyzes the impact of new or revised changes to legislation before the Congress pertaining to mentioned programs. Researches all program issues and develop the appropriate response that includes CMS regulations, or policy issuances. Analyzes internal policies, processes, and procedures to assure increased efficiency in operations and implements them to resolve problems and improve internal operations. Requirements Conditions of employment You must be a U.S. Citizen or National to apply for this position. You will be subject to a background and suitability investigation. If you are selected for this position, the documentation that you present for purposes of completing the Department of Homeland Security (DHS) Form I-9 will be verified through the DHS "E-Verify" System. All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choice. Selective Service: Males born after December 31, 1959, must be registered or exempt from Selective Service - http://www.sss.gov One-year probationary period may be required. Qualifications ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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 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) Implementing program policies related to Medicaid, CHIP, or the Basic Health Program (BHP) to ensure compliance with federal regulations and program objectives; 2) Providing technical guidance on Medicaid, CHIP, or BHP program policies; and 3) Developing regulations, manuals, program guidelines, program memoranda, policy letters, or instructions to communicate health insurance program policies. 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. Additional information Bargaining Unit Position: Yes - American Federation of Government Employees, Local 2268 Tour of Duty: Flexible Recruitment Incentive: Not Authorized 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. CMS offers flexible working arrangements and allows employees the opportunity to participate in alternative work schedules at the manager's discretion. 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/employee_guides/career_transition.asp. https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/2026/general-schedule/ Locality- Boston: $120,548 - $156,715 Dallas: $115,711 - $150,426 Kansas City: $108,173 - $140,627 Seattle: $119,630 - $155,521 Woodlawn: $121,785 - $158,322 Expand Hide  additional information Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution. Benefits A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits. Review our benefits Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.