Health Insurance Specialist

Summary This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI). As a Health Insurance Specialist, GS-0107-7/9, you will perform assignments associated with education, outreach, and customer service aimed at private health insurance consumers, beneficiary/provider populations and interest groups, and other stakeholders. Responsibilities The incumbent serves as a Health Insurance Specialist in a developmental capacity by preparing and implementing elements of tactical communications plans or strategic partnerships that provide information and promote awareness of limited segments of CMS programs and initiatives. The incumbent participates in studies to identify potential problem areas that may benefit from education and training interventions, serves as conduit between internal CMS and external stakeholders to support CMS' established presence, obtains feedback that can help CMS implement education strategies about its health insurance programs, and conducts field studies and surveys related to education and training. The incumbent provides guidance and assistance to regional offices and contracted stakeholders on education, outreach, and training initiatives and assists in providing training and assistance to regional offices for the review and evaluation of the institutional provider, physician, supplier, and beneficiary overpayment recovery and third party systems. The incumbent responds to routine inquiries regarding program-related activities to a variety of internal and external stakeholders. The incumbent conducts routine analytical studies and evaluates the effectiveness of program initiatives by gathering, organizing, and interpreting data making recommendations supported by facts and background information. 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 receiving further consideration. In order to qualify for the GS-07, 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-05 grade level in the Federal government, obtained in either the private or public sector, to include: Drafting consumer education materials, such as brochures, fact sheets, or web content, to communicate health insurance program options to customers; AND Gathering background information to support routine outreach or liaison activities related to health insurance program education, under the guidance of a senior specialist; AND Researching applicable laws, regulations, or policies to respond to routine customer inquiries about health insurance programs, such as Medicare, Medicaid, the Children's Health Insurance Program (CHIP), or the Health Insurance Marketplace. - OR - Substitution of Education for Experience: You may substitute successful completion of a bachelor's degree from an accredited college or university in a course of study that demonstrates the knowledge, skills, and abilities necessary to do the work and I meet at least one of the requirements for superior academic achievement (SAA): 1. Class standing -- Applicants must be in the upper third of the graduating class in the college, university, or major subdivision, such as the College of Liberal Arts or the School of Business Administration, based on completed courses. 2. Grade-point average (G.P.A.) -- Applicants must have a grade-point average of 3.0 or higher out of a possible 4.0 ("B" or better) as recorded on their official transcript, or as computed based on 4 years of education, or as computed based on courses completed during the final 2 years of the curriculum; or 3.5 or higher out of a possible 4.0 ("B+" or better) based on the average of the required courses completed in the major field or the required courses in the major field completed during the final 2 years of the curriculum. (Grade-point averages are to be rounded to one decimal place. For example, 2.95 will round to 3.0 and 2.94 will round to 2.9.) 3. Election to membership in a national scholastic honor society -- Applicants can be considered eligible based on membership in one of the national scholastic honor societies. Membership in a freshman honor society cannot be used to meet the requirements of this provision. (You must submit transcripts.) -OR- Substitution of Education for Experience: You may substitute successful completion of one full year of graduate level education leading to a master's or equivalent graduate degree from an accredited college or university and my education demonstrates the knowledge, skills, and abilities necessary to do the work. (You must provide supporting transcripts). - OR - Combination of Experience and Education: A combination of the above-described specialized experience and education. I have some specialized experience as described in A, but less than one year; and I have more than one year but less than two years of education as described in B. I have computed the percentage of the requirements that I meet, and the total is at least 100%. (To compute the percentage, divide your total months of qualifying experience by 12. Then divide your semester hours of graduate education beyond one year by 18. Add the two percentages. The total percentage must equal at least 100 percent to qualify. (You must submit transcripts.) TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the "Required Documents" section below for the documentation required at the time of application. In order to qualify for the GS-09, 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-07 grade level in the Federal government, obtained in either the private or public sector, to include: Preparing and disseminating consumer education materials, such as publications, brochures, fact sheets, or web content, to communicate health insurance program options to customers, such as Health Insurance Marketplace consumers, Medicare beneficiaries, Medicaid program officials, or healthcare providers; AND Participating in outreach activities, such as public relations events, conferences, or presentations, to support health insurance program initiatives; AND Conducting studies to identify potential problem areas that may benefit from education or training interventions related to health insurance programs. - OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-09 level by possessing a Master's or equivalent graduate degree or 2 full years of progressively higher-level graduate education leading to such a degree or LL.B. or J.D., if related to the position being filled. - OR - Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-07 grade level may be used to qualify applicants for positions at the grade GS-09. Therefore, only education in excess of 1 full year of graduate-level education may be used to combine education and experience. TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the "Required Documents" section below for the documentation required at the time of application. 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 or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year 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 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