Health Insurance Administration Jobs

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Communications (OC), Call Center Operations Group, Division of Call Center Operations. As a Lead Health Insurance Specialist, GS-0107-14, you will oversee 1-800-MEDICARE call center operations, collaborate with staff and leadership to improve customer service and contractor compliance, and guide specialists in problem-solving, work methods, and project execution. Provides oversight and authoritative direction in the development, implementation, and management requirements for 1-800 Medicare. Serves as coach, facilitator, and/or negotiator in coordinating division initiatives among team members and other divisions. Leads lower-level specialists and team members in assessing program strengths and weaknesses, exploring alternatives, and identifying improvements to work methods, processes, and procedures. 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: Advising team members on problem-solving methods and work procedures to resolve operational issues; Monitoring call center contractor performance to identify operational trends and improvement opportunities; and Analyzing proposed policies, regulations, or legislation to determine their impact on contractor operations. 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/13104817

We are looking to fill Health Insurance Specialist, GS-0107-7/9, positions in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS). Click on "Learn more about this agency" for more details! What is a Health Insurance Specialist (HIS)? At CMS, an HIS can wear many hats. This series typically works with health insurance policy development, research, analysis, and program development. NOTE: The announcement closing date has changed to 11/6/26. Resolve health insurance program issues by conducting research on the problem area, analyzing the results, and making recommendations to management to resolve any problem areas. Engage with senior analysts and management in reviewing, analyzing, and developing program documents. Review, evaluate, and analyze health insurance programs for efficiency and effectiveness. Review draft regulations and responses to CMS' proposed regulations. Assist with the administration of health insurance program audits. PROGRAM REQUIREMENTS: You must be ELIGIBLE and QUALIFIED in order to be referred to Hiring Managers. ELIGIBILITY REQUIREMENTS: Am I considered a Recent Graduate? GPA Requirement: You must possess a cumulative GPA of 3.0 on the unweighted 4.0 scale upon completion of your academic degree or certificate program. (GPA 2.95 is rounded to 3.0, and 2.94 is rounded to 2.9.) To be eligible as a Recent Graduate: Individuals who, within the previous 2 years, completed a qualifying associate's, bachelor's, master's, professional, doctorate, vocational, or technical degree or certificate from a qualifying educational institution. Therefore, you must have completed your educational program no earlier than November 5, 2024. Veterans who were precluded from applying due to their military service obligation, begin their 2-year eligibility period upon release or discharge from active duty. Eligibility for veterans cannot exceed 6 years from the date on which they completed their degrees (or certification). Therefore, veterans must have completed your educational program no earlier than November 5, 2020. To verify your eligibility as a Recent Graduate, you must submit the following at the time of application: A copy of your unofficial transcripts from the educational institution you attended attesting to your possession of the required education. Your unofficial transcripts must reflect: (1) your name; (2) overall grade point average (GPA); and (3) Degree Type (e.g., Bachelor's, Master's, etc.) and Degree Major; AND (4) the date your Degree was conferred. Failure to submit proof of degree/certificate completion at the time of application will result in the withdrawal of your application from consideration for this position. To be eligible as a Degree Candidate for Fall 2026: Individuals who are degree candidates for this current semester/term, i.e., Fall 2026, scheduled to complete a qualifying Associate's, Bachelor's, Master's, Doctorate, professional, vocational, or technical degree or certificate program, AND the degree/certificate has not been conferred at the time of application. To verify your eligibility as a Degree Candidate for Fall 2026, you must submit the following at the time of application: A copy of your unofficial transcripts from the educational institution you attended attesting to your education completed to date. Your unofficial transcripts must reflect: (1) your name; (2) overall grade point average (GPA); (3) current enrollment; AND (4) Degree Type (e.g., Bachelor's, Master's, etc.) and Degree Major. If referred and selected, you must submit an additional unofficial transcript that confirms the date your degree was conferred before an Official Offer can be made. Degree must be conferred by January 31, 2027. Failure to submit proof of degree/certificate completion will result in the withdrawal of your application from consideration for this position. Note: For those applying as Degree Candidates for Fall 2026, you will be required to submit an additional transcript that confirms the above major or course requirements and the date your degree was conferred. Degree requirements must be completed during the Fall 2026 semester, and the degree must be conferred by January 31, 2027. Failure to submit proof of degree/certificate completion will result in the withdrawal of your application from consideration for this position. QUALIFICATION REQUIREMENTS: Do I qualify for the GS-07 or GS-09 Grade Level? In order to qualify for the GS-07, you must meet one of the following: Specialized Experience: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-05 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Assisting in performing routine analytical studies; and 2)Preparing written materials (e.g., position papers, briefing materials, procedures) for senior staff. - OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-07 grade level by possessing at least one full year of graduate-level education. One year of full-time graduate education is considered to be the number of credit hours that the school has determined to represent 1 year of full-time study. If that information cannot be obtained from the school, 18 semester hours should be considered as satisfying the 1 year of full-time study requirement. Part-time graduate education is creditable in accordance with its relationship to a year of full-time study at the school attended - OR - Superior Academic Achievement: A bachelor's degree from an accredited college or university AND one of the following provisions of superior academic achievement: A grade-point average of "B" (3.0 or higher on a 4.0 scale) for all completed undergraduate courses or those completed in the last two years of undergraduate study. For example, 2.95 is rounded to 3.0, and 2.94 is rounded to 2.9. A grade-point average of 3.5 or higher on a 4.0 scale for all required courses completed in your major field of study, or those required courses in your major completed in the last two years of your undergraduate study. Rank in the upper one-third of your class in the college, university, or major subdivision. Membership in a national honor society (other than freshman honor societies) recognized by the Association of College Honor Societies. - OR - Combination of Experience and Education: Equivalent combinations of successfully completed post-high school education and experience may be used to meet total experience requirements at the GS-07 grade level. The percentage of your total qualifying experience the education must equal to 100% to qualify for this grade. In order to qualify for the GS-09, you must meet one of the following: Specialized Experience: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-07 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Performing routine analytical studies related to healthcare programs or policies; and 2) Assisting with developing health insurance operational guidance policies, reports, or procedures. - OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-09 grade level by possessing a Master's Degree or equivalent graduate degree, or at least 2 full years of progressively higher level graduate education leading to such a degree, or LL.B. or J.D. - OR - Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-07 grade level may be used to qualify applicants for positions at the GS-09 grade level. Therefore, only education in excess of one full year of graduate-level education may be used to combine education and experience. ALL TRANSCRIPTS are required at the time of application to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see "Required Documents" section below on what documentation is required. Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/13103667

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity. As a Health Insurance Specialist, GS-0107-14, you will serve as an advisor to the Director and Deputy Directors of CPI, providing technical guidance and staff-level project management for efforts associated with the development and implementation of program integrity policies and initiatives. Serving as a trusted advisor to the Center's Director and Deputy Directors on critical healthcare policy issues that impact billions in Medicare and Medicaid spending. Leading and coordinating the Center's highest priority projects that span multiple government agencies, Congressional offices, and healthcare industry partners. Representing CMS in high-level meetings with Congress, federal agencies, state governments, and healthcare industry leaders to build partnerships focused on preventing healthcare fraud. Analyzing emerging trends and issues in the healthcare sector that could impact Medicare, Medicaid, and CHIP programs. Creating comprehensive written materials, including policy recommendations and executive briefings, that influence major federal healthcare decisions. 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.Leading or coordinating cross-cutting Medicare and/or Medicaid program integrity projects or initiatives across CMS Centers, Offices, or with external federal, state, or private entities; and 2 Analyzing Medicare and/or Medicaid laws, regulations, policies, or program data to identify vulnerabilities and determine their impact on program integrity operations, including fraud, waste, and abuse prevention or detection; and 3. Developing written products such as briefing papers, memorandum, policy or option papers to advise senior officials on 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/13089626

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare (CM).. As a Health Insurance Specialist, GS-0107-14, you will lead Hospital Price Transparency policy development, regulatory alignment, interagency coordination, and technical oversight to advance national healthcare pricing transparency initiatives. Leading development of Hospital Price Transparency regulations, guidance, and public comment responses; evaluate policy alternatives and advise senior leadership on complex regulatory issues. Aligning with Hospital Price Transparency policies with the Transparency in Coverage rule and No Surprises Act through legislative analysis and coordination across CMS, HHS, Labor, and Treasury. Advising senior CMS and HHS officials on transparency policy and represent CMS in interagency meetings and stakeholder discussions to advance national healthcare pricing transparency priorities. Directing contractors and analysts, establish priorities, review policy products, and coordinate policy, compliance, enforcement, legal, and operational teams to ensure effective policy implementation. 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. Leading the development of healthcare regulations, guidance, and public comment adjudication for high-impact national policies; 2. Applying understanding of complex contracting methodologies for hospital items and services to address program operations and policy priorities; 3. Coordinating interagency healthcare policy involving overlapping statutory authorities, including the Social Security Act and Public Health Service Act; AND 4. Advising senior leaders on sensitive policy matters, direct technical teams, and align stakeholders with competing interests. 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/13101289

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI). As a Health Insurance Specialist, GS-0107-7/9, you will perform assignments associated with education, outreach, and customer service aimed at private health insurance consumers, beneficiary/provider populations and interest groups, and other stakeholders. The incumbent serves as a Health Insurance Specialist in a developmental capacity by preparing and implementing elements of tactical communications plans or strategic partnerships that provide information and promote awareness of limited segments of CMS programs and initiatives. The incumbent participates in studies to identify potential problem areas that may benefit from education and training interventions, serves as conduit between internal CMS and external stakeholders to support CMS' established presence, obtains feedback that can help CMS implement education strategies about its health insurance programs, and conducts field studies and surveys related to education and training. The incumbent provides guidance and assistance to regional offices and contracted stakeholders on education, outreach, and training initiatives and assists in providing training and assistance to regional offices for the review and evaluation of the institutional provider, physician, supplier, and beneficiary overpayment recovery and third party systems. The incumbent responds to routine inquiries regarding program-related activities to a variety of internal and external stakeholders. The incumbent conducts routine analytical studies and evaluates the effectiveness of program initiatives by gathering, organizing, and interpreting data making recommendations supported by facts and background information. 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 receiving further consideration. In order to qualify for the GS-07, 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-05 grade level in the Federal government, obtained in either the private or public sector, to include: Drafting consumer education materials, such as brochures, fact sheets, or web content, to communicate health insurance program options to customers; AND Gathering background information to support routine outreach or liaison activities related to health insurance program education, under the guidance of a senior specialist; AND Researching applicable laws, regulations, or policies to respond to routine customer inquiries about health insurance programs, such as Medicare, Medicaid, the Children's Health Insurance Program (CHIP), or the Health Insurance Marketplace. - OR - Substitution of Education for Experience: You may substitute successful completion of a bachelor's degree from an accredited college or university in a course of study that demonstrates the knowledge, skills, and abilities necessary to do the work and I meet at least one of the requirements for superior academic achievement (SAA): 1. Class standing -- Applicants must be in the upper third of the graduating class in the college, university, or major subdivision, such as the College of Liberal Arts or the School of Business Administration, based on completed courses. 2. Grade-point average (G.P.A.) -- Applicants must have a grade-point average of 3.0 or higher out of a possible 4.0 ("B" or better) as recorded on their official transcript, or as computed based on 4 years of education, or as computed based on courses completed during the final 2 years of the curriculum; or 3.5 or higher out of a possible 4.0 ("B+" or better) based on the average of the required courses completed in the major field or the required courses in the major field completed during the final 2 years of the curriculum. (Grade-point averages are to be rounded to one decimal place. For example, 2.95 will round to 3.0 and 2.94 will round to 2.9.) 3. Election to membership in a national scholastic honor society -- Applicants can be considered eligible based on membership in one of the national scholastic honor societies. Membership in a freshman honor society cannot be used to meet the requirements of this provision. (You must submit transcripts.) -OR- Substitution of Education for Experience: You may substitute successful completion of one full year of graduate level education leading to a master's or equivalent graduate degree from an accredited college or university and my education demonstrates the knowledge, skills, and abilities necessary to do the work. (You must provide supporting transcripts). - OR - Combination of Experience and Education: A combination of the above-described specialized experience and education. I have some specialized experience as described in A, but less than one year; and I have more than one year but less than two years of education as described in B. I have computed the percentage of the requirements that I meet, and the total is at least 100%. (To compute the percentage, divide your total months of qualifying experience by 12. Then divide your semester hours of graduate education beyond one year by 18. Add the two percentages. The total percentage must equal at least 100 percent to qualify. (You must submit transcripts.) TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the "Required Documents" section below for the documentation required at the time of application. In order to qualify for the GS-09, 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-07 grade level in the Federal government, obtained in either the private or public sector, to include: Preparing and disseminating consumer education materials, such as publications, brochures, fact sheets, or web content, to communicate health insurance program options to customers, such as Health Insurance Marketplace consumers, Medicare beneficiaries, Medicaid program officials, or healthcare providers; AND Participating in outreach activities, such as public relations events, conferences, or presentations, to support health insurance program initiatives; AND Conducting studies to identify potential problem areas that may benefit from education or training interventions related to health insurance programs. - OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-09 level by possessing a Master's or equivalent graduate degree or 2 full years of progressively higher-level graduate education leading to such a degree or LL.B. or J.D., if related to the position being filled. - OR - Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-07 grade level may be used to qualify applicants for positions at the grade GS-09. Therefore, only education in excess of 1 full year of graduate-level education may be used to combine education and experience. TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the "Required Documents" section below for the documentation required at the time of application. 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/13100380

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation(CMMI), Patient Care Models Group (PCMG), Division of Payment Models (DPM). As a Supervisory Health Insurance Specialist, GS-0107-14, you will direct staff responsible for the development and implementation of comprehensive health care and payment policies for advanced episode-based payment models. Direct the activities necessary to ensure the successful completion of planning, development, and implementation of new and existing episode payment models. Implement and manage existing episode-based payment models and demonstrations that test innovative healthcare payment and delivery approaches to examine implications for Medicare and/or Medicaid policy and regulations. Lead and manage the development of comprehensive health care and payment policies for new models, including developing alternative payment methodologies, writing requests for applications, and working with stakeholders on model feedback. Represent the Director at meetings, on task forces, and working groups, internally and externally, as needed, and assemble and direct teams or task forces for the duration of special assignments or projects. 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-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: Analyzing policies to determine the impact on program operations; AND Collaborating with teams and a range of stakeholders on model development; AND Developing or implementing alternative payment models. 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/13100765

Department of Health & Human Services, Centers for Medicare & Medicaid Services, Center for Medicare, Medicare Enrollment and Appeals Group (MEAG), Division of Medicare Enrollment Coordination (DMEC). As a Supervisory Health Insurance Specialist (Division Director), GS-0107-15, serves as the Division Director with the overall responsibility for directing, coordinating, and integrating the functions of staff with the work of other internal and external organizations. Overseeing work activities of teams responsible for operational changes to Medicare beneficiary programs. Developing technical instructions on policies related to Medicare beneficiary enrollment for stakeholders. Analyzing new or proposed legislation to determine the impact on current operations and develops implementation plans. Serve as a business owner and system manager for several Medicare enrollment systems. Collaborates with industry stakeholders on best practices for the security, exchange of beneficiary data, and resolving complex enrollment related issues. 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-15 , 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-14 grade level in the Federal government, obtained in either the private or public sector, to include: 1. Overseeing work activities of teams responsible for operational changes to Medicare beneficiary programs; 2. Developing technical instructions on policies related to Medicare beneficiary enrollment for stakeholders; and 3. Analyzing new or proposed legislation to determine the impact on current operations. 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/13102092

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare (CM). As a Supervisory Health Insurance Specialist, GS-0107-15, you will direct a division and its staff in developing, analyzing, interpreting, and implementing policies and standards for the Medicare Shared Savings Program. Develops policy, technical specifications, guidance and procedures for the Medicare Shared Savings Program. Conducts policy analysis for senior CMS officials and manages implementation activities for the Medicare Shared Savings Program, including beneficiary assignment, benchmarking, data sharing and financial reconciliation. Provides expert consultation to internal and external shareholders to provide responses to inquiries from providers, Congress, and the public. Coordinates with other CMS components and oversight bodies like the Office of Inspector General (OIG) and Government Accountability Office (GAO). Leads multidisciplinary staff by planning work, setting priorities, and preparing schedules for task completion. Conducts formal performance appraisals, leave approval and training requests, interviews candidates, and handles disciplinary actions ranging from written warnings to recommending more serious measures. 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-15 , 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-14 grade level in the Federal government, obtained in either the private or public sector, to include: 1. Leading data analysis and the development and implementation of Medicare value-based payment and Medicare Shared Savings Program payment policies and rulemaking; 2. Advising senior officials and internal and external stakeholders on Medicare value-based payment policy and operations; and 3. Leading Medicare payment policy and analytic teams engaged in such work, including operations of the 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. 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/13099881

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare (CM). As a Supervisory Health Insurance Specialist, GS-0107-15, you will direct a division and its staff in developing, analyzing, interpreting, and implementing policies and standards for the Medicare Shared Savings Program. Develops policy, technical specifications, guidance and procedures for the Medicare Shared Savings Program. Conducts policy analysis for senior CMS officials and manages implementation activities for the Medicare Shared Savings Program, including beneficiary assignment, benchmarking, data sharing and financial reconciliation. Provides expert consultation to internal and external shareholders to provide responses to inquiries from providers, Congress, and the public. Coordinates with other CMS components and oversight bodies like the Office of Inspector General (OIG) and Government Accountability Office (GAO). Leads multidisciplinary staff by planning work, setting priorities, and preparing schedules for task completion. Conducts formal performance appraisals, leave approval and training requests, interviews candidates, and handles disciplinary actions ranging from written warnings to recommending more serious measures. 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-15, 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-14 grade level in the Federal government, obtained in either the private or public sector, to include: Leading data analysis and the development and implementation of Medicare value-based payment and Medicare Shared Savings Program payment policies and rulemaking; Advising senior officials and internal and external stakeholders on Medicare value-based payment policy and operations; and Leading Medicare payment policy and analytic teams engaged in such work, including operations of the 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. 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/13095854

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation(CMMI), Policy & Programs Group (PPG), Division of Alternative Payment Model Infrastructure (DAPMI). As a Supervisory Health Insurance Specialist, GS-0107-15, you will oversee staff and contractors who provide policy development support for Alternative Payment Models (APM). Direct the work of Health Insurance Specialists and Social Science Research Analysts. Assign work to subordinates based on priorities, selective consideration of the difficulty and requirements of assignments, and the capabilities of employees. Direct formulation of policies related to the APM provisions of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Manage the development of comprehensive health care and payment policies for new models, including developing alternative payment rates, preparing provider agreements, and ensuring the availability of the necessary waiver language of each model. Develop and maintain collaborative relationships through mutual understanding of providers' needs and concerns while simultaneously engaging providers in CMS goals of providing better care and better health at lower cost. 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-15 , 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-14 grade level in the Federal government, obtained in either the private or public sector, to include: Leading cross-functional project teams, to include planning, organizing, or assessing work activities, in developing policies or guidelines related to healthcare payment models; AND Advising stakeholders on the statutes or regulations (e.g., Medicare Access and Chip Reauthorization Act of 2015) related to developing Alternative Payment Models; AND Collaborating with stakeholders (e.g., CMS representatives, Federal agencies, state agencies, healthcare providers, clinical experts, Congressional Members) to improve healthcare outcomes for beneficiaries. 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/13097951

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Financial Management OFM, Payment Accuracy and Reporting Group (PARG). As a Health Insurance Specialist, GS-0107-13, you will serve as the primary CMS focal point for functional administration and oversight of the Comprehensive Error Rate Testing (CERT) Program, and for internal and external reporting. Provide expert policy analysis and technical guidance on the Payment Integrity Information Act (PIIA) and Medicare Fee-for-Service (FFS) improper payment measurement program. Guide CMS contractors and Medicare Administrative Contractors (MACs) in implementing program policies, reviewing improper payment reports and reduction strategies, and educating stakeholders on compliance and reporting requirements. Develop, implement, and evaluate program initiatives to improve operational efficiency, identify root causes of improper payments, mitigate risks, and recommend policy and procedural improvements. Conduct special studies, comparative analyses, and program evaluations to assess payment integrity, identify emerging trends, validate analytical models, and determine the feasibility of large-scale reviews and audits. Prepare regulations, sub-regulatory guidance, briefing materials, congressional reports, and financial reporting content; advise CMS leadership, represent the agency before stakeholders, and coordinate responses to complex program inquiries. 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, 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: Providing support to improper payment measurement contractors on Medicare Fee-for-Service (FFS) policies and requirements; AND, Communicating to the public or medical professionals on the coverage policies related to the items and services that are eligible for payment under Medicare FFS rules; AND, Educating providers, beneficiaries, and stakeholders on compliance, billing, reporting, or other operational aspects of the Medicare FFS program; AND, Preparing briefing materials or reports, such as contributing to the Payment Integrity Report section of the annual Agency Financial Report (AFR) and compiling supplemental improper payment data for program oversight and transparency. 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/13098495