Health Insurance Specialist (Program Oversight)

Centers for Medicare & Medicaid Services

Summary This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare(CM) Medicare Plan Payment Group (MMPG) in Woodlawn, Maryland. As a Health Insurance Specialist (Program Oversight), GS-0107-13, you will develop and implement policies involved with the monitoring and oversight of CMS health plans programs band oversee policy development, stakeholder relations, compliance, and inquiry responses. Responsibilities Develop of policies for activities and processes involved with the monitoring and oversight of external CMS stakeholders who provide services in support of CMS health care plans. Implement, and maintain operational requirements, a comprehensive program oversight strategy including standard operating procedures for oversight of entities that provide health care and prescription drug services. Evaluate and analyze the impact of new or revised changes to legislation before the Congress pertaining to provide guidance to state health administation. Respond to inquiries regarding program oversight activities to a variety of internal and external stakeholders. Develop project plans to ensure logistics are handled efficiently, identifying potential bottlenecks and resolving issues within the scope of authority. 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 GS-12 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Developing oversight strategies to health care or prescription drug service providers; and (2) Evaluating methods used to identify vulnerabilities in a national health insurance program; and (3) Analyzing research or data to propose improvements to a health insurance program. 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: Education Additional Information Bargaining Unit Position: Yes-American Federation of Government Employees, Local 1923 OR No 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 managers 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. 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 OPMs Career Transition Resources website at

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