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Health Insurance Specialist

Centers for Medicare & Medicaid Services
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We are looking to fill Health Insurance Specialist, GS-0107-7/9, positions in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS). Click on "Learn more about this agency" for more details!

What is a Health Insurance Specialist (HIS)? At CMS, an HIS can wear many hats. This series typically works within health insurance policy development, research, analysis, and program development.

Duties

  • Resolve health insurance program issues by conducting research on the problem area, analyzing the results, and making recommendations to management to resolve any problem areas.
  • Engage with senior analysts and management in reviewing, analyzing, and developing program documents.
  • Review, evaluate, and analyze health insurance programs for efficiency and effectiveness.
  • Review draft regulations and responses to CMS' proposed regulations.
  • Assist with the administration of health insurance program audits.

Requirements

Conditions of Employment

  • You must be a U.S. Citizen or National to apply for this position.
  • You must possess a cumulative GPA of 3.0 or higher on a 4.0 scale.
  • You must meet all program, qualification and education requirements.
  • You will be subject to a background and suitability investigation.
  • You must sign a Pathways Participant Agreement before starting employment.

Qualifications

PROGRAM REQUIREMENTS: You must be ELIGIBLE and QUALIFIED in order to be referred to Hiring Managers.

ELIGIBILITY REQUIREMENTS: Am I considered a Recent Graduate?

GPA Requirement: You must possess a cumulative GPA of 3.0 on the unweighted 4.0 scale upon completion of your academic degree or certificate program. (GPA 2.95 is rounded to 3.0 and 2.94 is rounded to 2.9.)

To be eligible as a Recent Graduate:

  • Individuals who within the previous 2 years, completed a qualifying associates, bachelors, masters, professional, doctorate, vocational or technical degree or certificate from a qualifying educational institution. Therefore, you must have completed your educational program no earlier than December 3, 2022. Veterans who were precluded from applying due to their military service obligation, begin their 2-year eligibility period upon release or discharge from active duty. Eligibility for veterans cannot exceed 6 years from the date on which they completed their degrees (or certification). Therefore, veterans must have completed your educational program no earlier than December 3, 2018.
  • To verify your eligibility as a Recent Graduate, you must submit the following at the time of application: A copy of your unofficial transcripts from the educational institution you attended attesting to your possession of the required education. Your unofficial transcripts must reflect: (1) your name; (2) overall grade point average (GPA); and (3) Degree Type (e.g., Bachelor's, Master's, etc.) and Degree Major; AND (4) the date your Degree was conferred. Failure to submit proof of degree/certificate completion at time of application will result in the withdrawal of your application from consideration for this position.

To be eligible as a Degree Candidate for Fall 2024:

  • Individuals who are degree candidates for this current semester/term, i.e. Fall 2024, scheduled to complete a qualifying Associate's, Bachelor's, Master's, Doctorate, professional, vocational or technical degree or certificate program AND degree/certificate has not been conferred at time of application.
  • To verify your eligibility as a Degree Candidate for Fall 2024: you must submit the following at the time of application: A copy of your unofficial transcripts from the educational institution you attended attesting to your education completed to date. Your unofficial transcripts must reflect: (1) your name; (2) overall grade point average (GPA); (3) current enrollment; AND (4) Degree Type (e.g., Bachelor's, Master's, etc.) and Degree Major. If referred and selected, you must submit an additional unofficial transcript that confirms the date your degree was conferred before an Official Offer can be made. Degree must be conferred by January 31, 2025. Failure to submit proof of degree/certificate completion will result in the withdrawal of your application from consideration for this position.

Note: For those applying as Degree Candidates for Fall 2024, you will be required to submit an additional transcript that confirms the above major or course requirements and the date your degree was conferred. Degree requirements must be completed during the Fall 2024 semester and the degree must be conferred by January 31, 2025. Failure to submit proof of degree/certificate completion will result in the withdrawal of your application from consideration for this position.

QUALIFICATION REQUIREMENTS: Do I qualify at the GS-07 or GS-09 Grade Level?

In order to qualify for the GS-07, you must meet one of the following:

  • Specialized Experience: 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: 1) assisting in performing routine analytical studies; and 2) preparing written materials (e.g., position papers, briefing materials, procedures) for senior staff. . - OR -
  • Substitution of Education for Experience: You may substitute education for specialized experience at the GS-07 grade level by possessing at least one full year of graduate level education. One year of full-time graduate education is considered to be the number of credit hours that the school attended has determined to represent 1 year of full-time study. If that information cannot be obtained from the school, 18 semester hours should be considered as satisfying the 1 year of full-time study requirement. Part-time graduate education is creditable in accordance with its relationship to a year of full-time study at the school attended - OR -
  • Superior Academic Achievement: A bachelor's degree from an accredited college or university AND one of the following provisions of superior academic achievement:
    • A grade-point average of "B" (3.0 or higher on a 4.0 scale) for all completed undergraduate courses or those completed in the last two years of undergraduate study. For example, 2.95 is rounded to 3.0, and 2.94 is rounded to 2.9.
    • A grade-point average of 3.5 or higher on a 4.0 scale for all required courses completed in your major field of study, or those required courses in your major completed in the last two years of your undergraduate study.
    • Rank in the upper one-third of your class in the college, university, or major subdivision.
    • Membership in a national honor society (other than freshman honor societies) recognized by the Association of College Honor Societies. - OR -
  • Combination of Experience and Education: Equivalent combinations of successfully completed post-high school education and experience may be used to meet total experience requirements at the GS-07 grade level. The percentage of your total qualifying experience the education must equal to 100% to qualify for this grade.

In order to qualify for the GS-09, you must meet one of the following:

  • Specialized Experience: 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: 1) performing routine analytical studies related to healthcare programs or policies; and 2) assisting with developing health insurance operational guidance policies, reports, or procedures. - OR -
  • Substitution of Education for Experience: You may substitute education for specialized experience at the GS-09 grade level by possessing a Master's Degree or equivalent graduate degree or at least 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D. - 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 GS-09 grade level. Therefore, only education in excess of one full year of graduate level education may be used to combine education and experience.

ALL TRANSCRIPTS are required at the time of application to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see "Required Documents" section below on what documentation is required.

Click the following link to view the occupational questionnaire:

Education

Qualifications Continued:

NOTE: If you are using specialized experience to qualify for this position, your resume 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.

NOTE: A certificate program is defined as post-secondary education, in a qualifying educational institution, equivalent to at least one academic year of full-time study (30 undergrad credits/18 grad school credits) that is part of an accredited college-level, technical, trade, vocational, or business school curriculum.

Click the following link to view the occupational questionnaire:https://apply.usastaffing.gov/ViewQuestionnaire/12623595