Health Insurance Specialist (Program Policy)

Created at: September 20, 2025 00:10

Company: Centers for Medicare & Medicaid Services

Location: Philadelphia, PA, 19019

Job Description:

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of the Administrator (OA). As a Health Insurance Specialist, referred to here as Health Insurance Specialist (Program Policy), GS-0107-13, you will perform program policy work related to national health insurance programs.
ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT. 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. In order to qualify for the GS-13, 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-12 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Conducting analysis of national health insurance program policy issues in order to propose policy modifications; and (2) Developing regulations, manuals, program guidelines, program memoranda, policy letters, and/or instructions to communicate health insurance program policies; and (3) Presenting recommendations and conclusions based on analysis and evaluation of health insurance programs that describe feasible options and/or the consequences. 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: https://apply.usastaffing.gov/ViewQuestionnaire/12802898
Serve as an expert in interpreting statute and developing Federal regulations, policy statements, and other program guidance relating to national health insurance programs.
Identify and propose modifications to policies to reflect changes or trends in the health care industry, program objectives and the needs of beneficiaries.
Evaluate and analyze the impact of new or revised changes to legislation before the Congress pertaining to any CMS program.
Conduct analysis of policy issues and topics by researching background information, the origin of laws, and the intended impact in order to make effective policy recommendations.
Work with the CMS Office of Legislation and related Congressional committees and staff in performing an impact analysis or mark-up of various Congressional options before the committees.


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