Health Insurance Specialist (Data Analysis & Studies)

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 (MPPG), Division of Payment Reconciliation (DPR). As a Health Insurance Specialist, referred here as a Health Insurance Specialist (Data Analysis & Studies), GS-0107-13, you will perform data analysis and lead studies and projects related to Medicare programs.

Duties

• Design, plan, and conducts complex data analyses and studies supporting Medicare Part D operations/policy and Part C enrollment and encounter data operations/policy/
• Validate and interpret program data; identifies trends, disparities, data-quality issues, and operational risks; and develops technically sound recommendations.
• Research and analyze policy issues, laws, regulations, and program requirements and evaluates operational and data implications.
• Lead cross-functional project to improve data quality, business practices, operational requirements, reporting, and program performance.
• Prepare reports, metrics, briefings, presentations, and recommendations and work with stakeholders to resolve complex program and data issues.

Qualifications

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-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) Designing data studies to evaluate the impact of operations and policies on health insurance programs, including Medicare Advantage (Part C) or Part D; (2) Using qualitative and quantitative techniques to identify trends, root causes, and contributing factors affecting health insurance programs or healthcare administration; (3) Interpreting statute and federal regulations governing Medicare Parts C or D to assess program compliance or inform policy decisions; AND (4) Developing summary reports, briefings, or policy statements to explain qualitative and quantitative data from studies. 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/13084521

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. A Subject Matter Expert may assist in the resume review process to help determine whether you meet the minimum job qualifications. 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 Learning Reading Comprehension Self-Management 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. 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. 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. Locality- Atlanta: $112,556 - $146,325 Boston: $120,548 - $156,715 New York: $125,431 - $163,062 Seattle: $119,630 - $155,521 Woodlawn: $121,785 - $158,322