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), Exchange Customer Solutions Group. As a Health Insurance Specialist, GS-0107-11/12, you will develop, evaluate and implement compliance, audit and oversight requirements, policies, operating procedures related to activities and processes involved with the monitoring and oversight of external CMS stakeholders.

Duties

Develop, implement, and maintain program oversight strategy and processes, maintain operational requirements, including standard operating procedures and processes for overseeing entities that provide health care and prescription drug services. Monitor entities processes to identify program vulnerabilities and ensure continuing compliance with Agency agreements/contracts and all statutory, regulatory and sub-regulatory requirements are met. Gather and analyze information, conduct various reviews and studies to assess ongoing operations, program vulnerabilities, and initiate/recommend improvements or appropriate action. Develop, evaluate, and refine regulations, manuals, program guidelines, program memoranda, policy letters and instructions to effectively communicate policy to Agency stakeholders regarding compliance, audit and oversight programs.

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.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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-11, 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-09 grade level in the Federal government, obtained in either the private or public sector), to include: (1) Assisting in conducting research studies concerning trends of health plan operations in the Health Insurance Marketplace, to identify vulnerabilities and provide recommendations; AND (2) Assisting in analyzing health plan policy issues to resolve consumer/beneficiary complaints; AND (3) Assisting with preparing briefing materials or reports based on studies and analysis to provide metrics for leadership/decision makers. - OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher level graduate education leading to such a degree or equivalent doctoral degree or LL.M., if related to the position being filled. - OR - Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at the grade GS-11. Therefore, only education in excess of a master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree, may be used to combine education and experience. TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see "Required Documents" section below for what documentation is required at the time of application. 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) Conducting research studies concerning trends of health plan operations in the Health Insurance Marketplace, to identify vulnerabilities and provide recommendations; AND 2) Analyzing health plan policy issues to resolve consumer/beneficiary complaints; AND 3) Preparing briefing materials or reports based on studies and analysis to provide metrics for leadership/decision makers. Substitution of Education for Experience: There is no substitution of education to meet the specialized experience requirement at the GS-12 grade level. Combination of Experience and Education: There is no combination of experience and education to meet the specialized experience requirement at the GS-12 grade level. 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/12602673

Contacts

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