Health Insurance Specialist (Program Oversight)

Centers-For-Medicare-and-Medicaid-Services; San Francisco (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

Centers for Medicare and Medicaid Services seeks a Health Insurance Specialist (Program Oversight) at GS-12 to develop, evaluate, and implement compliance, audit and oversight requirements, policies, and procedures for monitoring external CMS stakeholders. The role emphasizes monitoring contractors and service providers to ensure adherence to CMS regulations and program objectives.

The position requires demonstrated experience at the GS-11 level in the federal environment, with a focus on

Qualifications

• Demonstrated experience at the GS-11 level or equivalent in the federal sector.
• Experience developing oversight processes for health care or prescription drug service providers.
• Ability to review health insurance program operations for compliance and effectiveness.

Responsibilities

• Develop, evaluate, and implement compliance, audit and oversight requirements, policies, and operating procedures for CMS stakeholders.
• Monitor external CMS contractors and service providers to ensure alignment with CMS regulations and program goals.

Skills

Oversight processes

Regulatory compliance

Program reviews

Job description

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS).

As a Health Insurance Specialist (Program Oversight), GS-0107-12, you will develop, evaluate, and implement compliance, audit and oversight requirements, policies, operating procedures related to monitoring and oversight of external CMS stakeholders who contract or provide services in support of CMS' lines of business.

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-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:

• Modifying oversight processes of health care or prescription drug service providers;
• Monitoring entities for compliance with health insurance program regulations and policies;
• Conducting reviews to assess health insurance program operations.

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.