Health Insurance Specialist

Summary This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), Fraud Investigations Group (FCLH). As a Health Insurance Specialist, GS-0107-13, you will analyze, develop, and implement a wide range of program integrity initiatives that support CMS' lines of business. Learn more about this agency Duties Analyze, develop and implement program integrity initiatives across Medicare, Medicaid, Children's Health Insurance Program (CHIP) and Marketplace 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. Collaborate across CMS and external partners on program integrity initiatives and projects. 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. May be required to serve a 1 year probationary period. 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 being considered further. In order to qualify for the GS-13 grade level, 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: Develop, evaluate and implement program integrity policies; and Evaluating health insurance program vulnerabilities to detect, fraud, waste or abuse; and Collaborating across organizational lines on investigations, audits or oversight of health insurance programs. 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. Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/12938217 Education This job does not have an education qualification requirement. Additional information Bargaining Unit Position: Yes, American Federation of Government Employees, Local 1923 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. Additional Salary Information: Atlanta: $112,556 to $146,325 Philadelphia: $117,284 to 152,471 Woodlawn: $121,785 to $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.