Health Insurance Specialist

Summary This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicaid and CHIP Services(CMCS), Operations Services Group (OSG). As a Health Insurance Specialist, GS-0107-13, you will serve as a subject matter expert on executive, regulatory, and enterprise operational matters affecting Medicaid, the Children's Health Insurance Program (CHIP), the Basic Health Program (BHP), and related Federal health coverage programs. Responsibilities Serves as a central coordinator for CMCS correspondence and regulatory clearance activities, ensuring consistency with Medicaid, CHIP, and Federal health coverage requirements. Coordinates regulatory reviews, SPAs, waivers, and program issuances; develops executive briefings and analytical materials; analyzes policies and operations to identify risks and recommend improvements. Resolves complex issues from Congressional inquiries, GAO/OIG oversight, FOIA/Privacy Act requests, and PRA requirements, ensuring consistent Medicaid and CHIP policy interpretation and compliance. Supports governance, oversight, and process improvements to strengthen program administration and implementation. Requirements Conditions of Employment Qualifications ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF 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: 1) Coordinating the review and clearance of Medicaid, CHIP (or any CMS health programs), and related Federal health coverage policy documents in accordance with applicable statutes and regulations. AND 2) Processing and implementing Paperwork Reduction Act (PRA) actions for Medicaid and CHIP program documents AND 3) Developing standard operating procedures (SOPs) and process enhancements to improve program administration and operational efficiency. AND 4) Advising internal and external stakeholders on Medicaid and CHIP program policies, regulatory requirements, and operational guidance. 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 Federal employees 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: Education Additional Information Bargaining Unit Position: Yes - American Federation of Government Employees, Local 2268 Tour of Duty: Flexible Recruitment Incentive: Not Authorized Relocation Incentive: Not Authorized Financial Disclosure: Not Required Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement. CMS offers flexible working arrangements and allows employees the opportunity to participate in alternative work schedules at the manager's discretion. 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