Health Insurance Specialist (Program Oversight)

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare. As a Health Insurance Specialist, referred here as a Health Insurance Specialist (Program Oversight), GS-0107-13, you will be responsible for developing, evaluating and implementing requirements, policies, and operating procedures for monitoring, compliance, and oversight activities related to Medicare and external CMS stakeholders.

Duties

• Serve as an expert in the development, evaluation, and implementation of Medicare, Providers and Private Health Plans.
• Develop, implement, and maintain operational requirements and comprehensive program oversight strategy that provide health care and prescription drug services,
• Develop and review health care policies and legislation in order to draft related policy documents, regulations, procedures and guidance to states.
• Gathers and analyzes information, conducts various reviews and studies to assess ongoing operations, program vulnerabilities and initiate and/or recommend improvements or appropriate action to ensure compliance.

Required Documents

• To apply for this position, you must submit a complete Application Package which includes:
• 1. Resume showing relevant experience; cover letter optional. NOTE: As of
• September 27, 2025, federal agencies will only accept resumes that are two pages or less in length. Your resume must indicate your citizenship and whether you are registered with the Selective
• Service if you are a male born after
• December 31, 1959. Your resume must also list your work experience and education (if applicable), including the start and end dates (mm/yyyy) of each employment, along with the number of hours worked per week. For work in the
• Federal service, you must include the series and grade level for the position(s). For resume and application tips, visit: https://help.usajobs.gov/faq/application/documents/resume/what-to-include. IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION. We strongly encourage applicants to utilize the
• USAJOBS resume builder in the creation of resumes. Determining length of general or specialized experience is dependent on the below information and failure to provide ALL information
• WILL result in a finding of ineligible. Official Position
• Title (include series and grade if Federal job)
• Duties (be specific in describing your duties)
• Employer's name and address
• Supervisor name and phone number
• Start and end dates in the month and year format (e.g. June 2007 to April 2008)
• Full-time or part-time status (include hours worked per week)
• Salary 2. CMS Required
• Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation
• WILL result in an ineligible rating
• OR non-consideration. 3. Reasonable Accommodation (RA)
• Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation
• Act of 1973 as amended, that would interfere with completing the USA Hire Competency Based
• Assessments, you will be granted the opportunity to request a
• RA in your online application. Requests for
• RA for the USA Hire Competency-Based
• Assessments and appropriate supporting documentation for
• RA must be received prior to commencing the USA Hire Competency-Based
• Assessments. Decisions on requests for
• RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency-Based
• Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the
• URL to access the USA Hire Competency-Based
• Assessments if you received the link after the close of the announcement. To determine if you need a
• RA, please click here to review the Procedures for Requesting a Reasonable Accommodation for Online Assessments.