Health Insurance Specialist (Program Oversight)

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS). As a Health Insurance Specialist (Program Oversight), GS-0107-12, you will develop, evaluate, and implement compliance, audit and oversight requirements, policies, operating procedures related to monitoring and oversight of external CMS stakeholders who contract or provide services in support of CMS' lines of business.

Duties

• Develop, implement, and maintain a comprehensive program oversight strategy and processes for overseeing entities that provide health care and prescription drug services.
• Establish and maintain relationships with internal and external stakeholders to resolve problems pertaining to program oversight.
• Gather and analyze information, conduct various reviews and studies to assess ongoing operations, program vulnerabilities, and initiate/recommend improvements or appropriate action.
• Prepare a variety of written products, including position papers, manuals, reports, correspondence, briefing materials, etc. for the assigned program area.

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-12, 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-11 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Modifying oversight processes of health care or prescription drug service providers; 2) Monitoring entities for compliance with health insurance program regulations and policies; and 3) Conducting reviews to assess health insurance program 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. Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/13043455

How You Will Be Evaluated

You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), the responses you provide on the application questionnaire, and the results of the online assessments required for this position. Please follow all instructions carefully. Errors or omissions may affect your rating. You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics): Attention to Detail Customer Service Decision Making Flexibility Integrity/Honesty Interpersonal Skills Reading Comprehension Stress Tolerance Teamwork In order to be considered for this position, you must complete all required steps in the process. In addition to the application and application questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job. Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on the online assessment may also result in your removal from consideration. You will be placed in one of the following categories based on category rating and selection procedures if you meet all of the requirements outlined in this job opportunity announcement: Best Qualified - for those who are superior in the evaluation criteria Well Qualified - for those who excel in the evaluation criteria Qualified - for those who only meet the minimum qualification requirements If you are found to be among the top-qualified candidates, you will be referred to the selecting official for employment consideration. This is a competitive vacancy announcement advertised under Delegated Examining Authority. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would therefore be given new appointments to the civil service; however, benefits, time served, and all other Federal entitlements would remain the same. The category rating process does not add veterans' preference points or apply the "rule of three" but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans' preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher). Other 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. Salary Ranges by Location: Atlanta, GA - $94,654 - $123,052 Boston, MA - $101,375 - $131,790 Chicago, IL - $100,059 - $130,080 Dallas, TX - $97,307 - $126,502 Denver, CO - $99,800 - $129,742 Kansas City, MO - $90,968 - $118,261 New York, NY - $105,481 - $137,128 San Francisco, CA - $111,896 - $145,468 Seattle, WA - $100,602 - $$130,786 Woodlawn, MD - $102,415 - $133,142 For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page. 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.