Health Insurance Specialist

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Offices of Hearings and Inquiries, Offices of Hearings and Inquiries. As a Health Insurance Specialist, GS-0107-11/12, you will perform analytical duties related to national health insurance programs, such as Medicare, Medicaid, the Children's Health Insurance Program (CHIP), Marketplace Exchange/private health insurance.

Duties

• •Conducting analysis of policy issues, researching background information and laws, and assessing intended impacts to develop effective policy recommendations.
• •Validating data for accuracy and completeness and refining data into formats for individual responses or summary reports.
• •Collaborating with CMS staff and stakeholders to develop innovative methods for determining and assuring the reliability and validity of productivity and workload data.

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-11, 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-09 grade level in the Federal government, obtained in either the private or public sector, to include: Analyzing data related to national health insurance programs, such as Medicare, Medicaid, CHIP, or the Marketplace Exchange, to identify trends, patterns, or risks affecting program operations; AND Combining data from multiple health insurance program systems to build a reliable dataset for analysis; AND Creating reports and visual displays from data to communicate findings to managers and staff; AND Utilizing data analysis tools to build dashboards and fix data quality issues. - OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher-level graduate education leading to such a degree or equivalent doctoral degree or LL.M., 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-09 grade level may be used to qualify applicants for positions at the grade GS-11. Therefore, only education in excess of a master's or equivalent graduate degree or 2 full years of progressively higher-level graduate education leading to such a degree 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. In order to qualify for the GS-12, 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-11 grade level in the Federal government, obtained in either the private or public sector, to include: Leading the analysis of data related to national health insurance programs, such as Medicare, Medicaid, CHIP, or the Marketplace Exchange, to identify significant trends or risks that shape program strategy or policy; AND Designing data pipelines that integrate data from multiple health insurance program systems to produce analysis-ready datasets supporting program evaluation; AND Developing dashboards and reports on Medicare, Medicaid, CHIP, or Marketplace program data to inform senior leadership decisions; AND Advising senior management with data-driven recommendations on health insurance program operations, policy, or compliance issues to support program improvements. Substitution of Education for Experience: There is no substitution of education to meet the specialized experience requirement at the GS-12 grade level. Combination of Experience and Education: There is no combination of experience and education to meet the specialized experience requirement at the GS-12 grade level. 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: https://apply.usastaffing.gov/ViewQuestionnaire/13071204

Education

TRANSCRIPTS are required to verify satisfactory completion of the educational requirement listed above. Please refer to the "Required Documents" section below for the documentation required at the time of application.