As a Health Insurance Specialist (Contracts) at the GS-0301-12/13, you will be part of Healthcare and Insurance, Office of Personnel Management. If selected, you will serve as a representative of the Contracting Officer and ensure that Federal Employees Health Benefits (FEHB) Program enrollees receive the benefits that have been established under the contract.

Duties

Reviews and analyzes evidence submitted by health plans applying for participation in the Federal Employees Health Benefits (FEHB) Program for compliance with the law, regulations, and office policies and practices. Recommends approval or rejection of applicants with supporting documentation. Monitors the contract and maintains contract files for assigned health benefits carriers. Advises carriers on OPM's implementation of changes in laws and regulations. Works with carriers to assist them in providing reports and documentation related to their performance in providing services and health benefits to enrollees. Assists in resolving and documenting actions to address any and all negative findings. Assists in the preparation of the health benefits brochures and other Open Season informational materials each calendar year. Ensures that the plan's brochure and marketing materials comply with the contract. Consults with other staff offices within the agency to obtain advice on various technical and medical questions. Participates in meetings to assess the carrier's contractual compliance with and full understanding of, contractual requirements and to preclude unauthorized changes or alterations in contract provisions. Monitors contractor performance and recommends solutions to problems associated with contract disputes. Builds productive working relationships with health plan administrators, union officials and underwriters. Issues correspondence as needed in support of the contract. Reviews all documentation, correspondence, and reports submitted by the carrier(s) to ensure that actions taken, services and products provided, and processes/procedures followed are in compliance with the final agreed upon contract. Reviews and recommends approval or rejection of carrier benefit changes or clarifications. Assists the Office of the Inspector General (OIG) with obtaining information from carriers to be used in conducting periodic audits. Conducts an annual performance assessment of assigned carriers and makes recommendations to the Contracting Officer regarding Service Charge or Performance Adjustment Scores. Responds to carriers inquiries or advises on implementation of topics within OPM's guidance (Call Letter, Technical Guidance, Carrier Letters).

Requirements

Qualifications

For the GS-12 Grade Level: You must have at least one year of specialized experience which is equivalent in difficulty and complexity to the GS-11 grade level in the Federal Service (obtained in either the private or public sector) which demonstrates at least two of the following activities: Knowledge of the Federal Acquisition Regulation (FAR), Federal Benefits Acquisition Regulation (FEHBAR), and Federal Employees Health Benefits (FEHB) program policies and/or requirements; Experience with and knowledge of health benefits, health insurance, or medical plans; Performing contract administration including oversight; Applying knowledge of health insurance regulations, policies or procedures in the administration of health benefits; Assisting in the development of health insurance contract requirements. For the GS-13 Grade Level: You must have one year of specialized experience comparable in scope and responsibility to the GS-12 grade level in the Federal service (obtained in either the private or public sector) which demonstrates broad knowledge of health insurance regulations, program policies or requirements, and at least two of the following activities: Experience with and broad knowledge of health benefits and industry; Performing contract administration and oversight for health benefits or related programs; Developing and implementing health insurance or similar program requirements; Experience with Medicare, Medicaid or other health insurance coordination of benefits. Merit promotion applicants must meet time-in-grade requirement as defined in 5 CFR 300, Subpart F. One year at the GS-11 grade level is required to meet the time-in-grade requirements for the GS-12 level. One year at the GS-12 grade level is required to meet the time-in-grade requirements for the GS-13 level. You must meet all qualification and eligibility requirements within 30 days of the closing date of this announcement. 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.

Contacts

• Address OPM Human Resources 1900 E St., NW Washington, DC 20415 US
• Name: Jaime Torres
• Phone: (202) 936-3066
• Email: [email protected]