Supervisory Health Insurance Specialist (Division Director)

Job Title

The duties of this position include:

Planning and assigning work, establishing priorities, evaluating performance, resolving employee concerns, approving personnel actions, and identifying training and development needs.

Directing the analysis, development, interpretation, and implementation of legislation, regulations, policies, and procedures governing Medicare appeals, grievances, and beneficiary dispute resolution.

Overseeing Medicare Advantage and Part D appeals operations involving regional offices, Independent Review Entities, the Office of Medicare Hearings and Appeals, and the Departmental Appeals Board.

Leading the development and administration of standardized beneficiary notices and policies that safeguard Medicare beneficiary rights, protections, and financial liability requirements.

Developing and approving manual instructions, rulings, change requests, technical direction letters, and policy guidance concerning appeals, grievances, and dispute resolution processes.

Representing CMS before HHS, OMB, congressional staff, federal agencies, contractors, health plans, provider organizations, beneficiary groups, and other stakeholders.

Evaluating division operations, implementing process improvements, recommending staffing and budget resources, and ensuring work products meet established quality, timeliness, and regulatory requirements.

Coordinating with CMS components, legal counsel, adjudicatory entities, and technology teams to resolve operational issues and improve Medicare appeals systems and workflows.

Department of Health and Human Services