Health Insurance Specialist

US Department of Health And Human Services - San Francisco, CA
$105,664 - $156,758 a year
    Duties Summary

    This position is located in the Centers for Medicare & Medicaid Services (CMS), Center for Medicaid and CHIP Services (CMCS), Children and Adults Health Programs Group (CAHPG), Division of Quality and Health Outcomes (DQHO) .

    As a Health Insurance Specialist, GS-0107-14, you will serve as a Technical Director providing program expertise on managed care and data analysis to drive quality improvement within Medicaid and the Children's Health Insurance Program (CHIP).


    Responsibilities
    • Assess, analyze, and define trends in emerging and existing policies/operations to determine their impact on program operations including conducting environmental scans and using information technology.
    • Provide strategic direction to address complex technical problems and policy issues related to Medicaid or CHIP, including analysis of performance metrics using key indicators and data sources.
    • Represent senior CMCS officials in discussions with senior CMS and Departmental officials, congressional staffs, interest groups and other members of the public.
    • Provide project direction and technical direction to lower graded specialists, defines individual team members task assignments, reviews members work for technical accuracy and clarity of communication.
    Travel Required

    Occasional travel - You may be expected to travel for this position.

    Supervisory status

    No

    Promotion Potential

    14

  • Job family (Series)

    0107 Health Insurance Administration

  • Requirements

    Requirements Conditions of Employment
    • 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.

    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-14 grade level in the Federal government, obtained in either the private or public sector, to include:
    (1) Providing technical guidance on the development and use of managed care quality policies and the analysis of quality and performance measurement data to drive quality improvement in Medicaid and the Children's Health Insurance Program,
    (2) Drafting health policy statements, guidelines, or procedural instructions to implement new initiatives;
    (3) Analyzing a variety of health care quality and policy data to drive quality improvement; AND
    (4) Collaborating and negotiating with various stakeholders for policy development, implementation, or program improvement.

    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/10610673 Education

    This job does not have an education qualification requirement.

    Additional information

    Bargaining Unit Position: Yes
    Tour of Duty: Flexible
    Recruitment/Relocation Incentive: Not Authorize
    Financial Disclosure: Not Required

    CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page.

    Additional Forms REQUIRED Prior to Appointment:

    • Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation - A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
    • Form I-9, Employment Verification and the Electronic Eligibility Verification Program - CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
    • Standard Form 61, Appointment Affidavits - If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.
    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.

    Additional selections may be made from this announcement for similar positions within CMS in the same geographical location. For Central Office vacancies, the "same geographical location" includes Baltimore, Maryland; Bethesda, Maryland; and Washington, D.C.

    If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application. How You Will Be Evaluated

    You will be evaluated for this job based on how well you meet the qualifications above.

    Once the announcement has closed, your online application, resume, and CMS required documents will be used to determine if you meet eligibility and qualification requirements listed on this announcement. If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration. Please follow all instructions carefully. Errors or omissions may affect your rating.

    Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):

    • Analysis
    • Health Insurance
    • Oral Communication
    • Project Management
    Background checks and security clearance Security clearance

    Not Required

    Drug test required

    No

    Position sensitivity and risk

    Noncritical-Sensitive (NCS)/Moderate Risk

    Trust determination process

    Credentialing, Suitability/Fitness

  • Required Documents

    Required Documents

    The following documents are REQUIRED:

    1. Resume showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/dd/yy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

    2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.

    PLEASE NOTE: A complete application package includes the online application, resume and CMS required documents. Please carefully review the full job announcement to include the "Required Documents" and "How to Apply" sections. Failure to submit the online application, resume and CMS required documents, will result in you not being considered for employment.

  • Benefits

    Benefits

    A career with the U.S. Government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Learn more about federal benefits.

    Review our benefits

    Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time, or intermittent. Contact the hiring agency for more information on the specific benefits offered.

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