Health Insurance Specialist

Duties

Providing oversight and technical assistance to states on Medicaid, CHIP, and BHP delivery systems, waivers, State Plan Amendments, payment policies, and program implementation.

Developing, analyzing, interpreting, and evaluating national policies, regulations, legislation, procedures, and guidance governing Medicaid, CHIP, BHP, and related health programs.

Reviewing state financing, reimbursement, eligibility, benefits, prescription drug, third-party liability, and other program policies to ensure compliance with applicable requirements.

Coordinating with states, territories, tribal organizations, Federal agencies, stakeholders, and Congressional staff to provide technical assistance, resolve program issues, and support policy implementation.

Conducting program analyses, studies, data reviews, and evaluations to assess program performance, policy impacts, financial operations, integrity risks, and opportunities to improve care and reduce costs.

Department of Health and Human Services