Health Insurance Specialist

Centers-For-Medicare-and-Medicaid-Services; Atlanta (GA); On-site; USD 100,000 - 140,000; Full time

Job summary

Centers for Medicare and Medicaid Services seeks a Health Insurance Specialist (GS-0107-13) to lead Medicaid managed care policy development, evaluation, and oversight, including program integrity and FWA activities within the group’s scope.

Qualifications require at least one year of specialized experience at GS-12 level and evidence of experience with statutes, regulations, and program requirements. This role emphasizes technical guidance to states and stakeholders.

Qualifications

• Must meet all qualification requirements by the closing date.
• One year of specialized experience at GS-12 or equivalent.
• Experience with federal statutes, regulations, and program requirements.

Responsibilities

• Analyze, develop, and implement Medicaid managed care statutes and regulations.
• Provide technical guidance to states and stakeholders to ensure compliance.
• Assess program integrity risk and recommend improvements.

Skills

Medicaid managed care policy

Regulatory guidance

Program integrity

Job description

Department of Health & Human Services, Centers for Medicare & Medicaid Services, Center for Medicaid and CHIP Services, Center for Medicaid and Children's Health Insurance Programs (CHIP), Managed Care Group (MCG).

As a Health Insurance Specialist, GS-0107-13, serves as an expert in the development, evaluation, implementation, and oversight of Medicaid Managed Care Policy, operations, program integrity, FWA activities within the Group's areas of responsibility.

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT. Your resume (limited to no more than 2 pages) 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 being considered further.

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:

• Analyzing, developing, and implementing statutes, regulations, or operational requirements governing Medicaid managed care or other comparable national health care plans or programs;
• Providing technical assistance, guidance, and subject-matter expertise to states and other stakeholders on Medicaid managed care requirements or similar national healthcare plans and/or programs to promote compliance with applicable federal statutes, regulations, and program requirements;
• Assessing program integrity risk and impact and developing recommendations and solutions to strengthen program oversight, compliance, and performance.

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.