This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Program Operations and Local Engagement (OPOLE). As a Health Insurance Specialist (Marketplace Appeal Reviewer), GS-0107-13, you will be responsible for conducting additional review of Affordable Care Act Exchange (Marketplace) appeal decisions

Duties

Review appeal decisions made by Federal Hearing Officers that originated from individuals regarding coverage eligibility under the Affordable Care Act’s Exchanges. Conduct appeal decision reviews in accordance with CMS regulations. Research the laws, regulations, and precedents related to the facts and the issues of appeal decisions. Propose modifications to operations or policies to reflect changes or trends in the health care industry, program objectives, and the needs of appellants. Assist in developing and reviewing training and materials, and leading training for other appeal decision reviewers, contractors, and colleagues.

Requirements

• You must be a U.S. Citizen or National to apply for this position.
• You will be subject to a background and suitability investigation.
• Time-in-Grade restrictions apply.

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 the GS-12 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Analyzing and evaluating applicants' eligibility for participation in the Health Insurance Exchange (Marketplace) or Medicaid or Children's Health Insurance Program (CHIP) programs. 2) Resolving problems and complaints from customers seeking health insurance coverage. 3) Providing guidance, technical assistance, and recommendations to internal and external stakeholders on the operations of the Health Insurance Exchange (Marketplace) or Medicaid or CHIP.. 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/12223542

Education

This job does not have an education qualification requirement.

Contacts

• Address Office of Program Operations and Local Engagement 7500 Security Blvd Woodlawn, MD 21244 US
• Name: CMS HR Inquiries
• Email: [email protected]