This position is located in the Performance Improvement (PI) group within Federal Employees Insurance Operations (FEIO), Healthcare and Insurance (HI). HI provides health insurance benefits under the Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) Programs for employees, retirees, and family members by managing a broad array of health plans under contract to OPM.

Duties

Makes recommendations for selection and maintenance of measures evaluated in the PPA, including new measures, measure updates and retirements, prioritization, weighting, benchmark selection, scoring and analysis of results across the portfolio of FEHB, PSHB and FEDVIP plans. Provides input to the annual plan review for all FEHB, PSHB and FEDVIP Carriers to validate or dispute scoring before final results are applied to allowable plan payment formulas. Monitors the PPA to detect vulnerabilities in the measure set or methodology, as well as individual and systematic elements of noncompliance by carriers. Identify, describe, build the business case for, and recommend needed program revisions. Prepares drafts for senior analyst review of internal and external program documents, including but not limited to PPA Carrier Letters, Operations Manuals, Methodology Manual, reports, white papers, and trend analyses, as well as accreditation programs and patient safety. Contributes to presentations and training modules on PPA processes for FEHB, PSHB and FEDVIP Carriers and HI staff. Conducts internal audit, reconciliation, and controls pertaining to the PPA. Compiles and communicates best practices through PPA data analysis, literature review, or market research. Participates in meetings with FEHB, PSHB and FEDVIP Contracting Officers and actuarial staff to support application of PPA scoring to final determination of applicable service charge (experience-rated plans) or performance adjustment (community-rated plans). When required, interfaces with select groups and divisions within Healthcare and Insurance as related performance improvement projects are prioritized by PI and HI leadership. Contributes to the proper administration of contracts and vendor relationships supporting PPA, including procurement, contractor evaluation, and exercising options including acting as a Contracting Officer Representative (COR) when so designated. Creates PPA content for the OPM website, FEHB and PSHB brochure templates, and applicable consumer choice tools supporting Open Season. Participates on the FEHB and PSHB PPA, and FEDVIP Workgroup cross functional teams. Assesses new developments and best practices in quality management, performance improvement, and accreditation

Requirements

Qualifications

For the GS-13 Grade Level: You must have one year of specialized experience at or equivalent to the GS-12 grade level or pay band in the Federal service or equivalent (obtained either in private or public sector) which demonstrates experience in gathering and analyzing information and presenting fully supported findings, conclusions, and recommendations in a well-structured format to inform management of problems and solutions and to contribute to sound decision-making. This experience must include the following activities: conducting quality assurance reviews in an assigned major area of functional activity, e.g., financial records and accountability; policy and program management; transaction processing; or data systems; advising managers on the development of plans for new or revised programs, operations and functions in light of budgetary guidelines and constraints, priorities and objectives; developing internal administrative and management policies, procedures and guidelines in the areas of human resources, operational support and planning services; creating analyses and projections of long and short-range changes in workloads, budget and staffing levels, support system requirements, training needs and similar factors affecting future organizational operations; and serving on task forces or work groups to examine special issues or problems. Applicants must meet applicable time-in-grade requirements to be considered eligible. One year at the GS-12 grade level is required to meet the time-in-grade requirements for the GS-13 grade level. You must meet all qualification and eligibility requirements by 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]