Health Insurance Specialist

Created at: September 30, 2025 00:02

Company: Centers for Medicare & Medicaid Services

Location: Boston, MA, 2101

Job Description:

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Program Operations and Local Engagement (OPOLE), Medicare Plan Management Group (MPMG). As a Health Insurance Specialist, GS-0107-14, you will assess a wide range of qualitative and quantitative issues and studies that relate to the Medicare program's effectiveness, efficiency, and/or improvement.
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-14, 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-13 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Performing program management functions that include policy, operations, and evaluation aspects of Medicare, Medicaid, or other health insurance programs; 2) Executing detailed analyses of health care program activities addressing areas of deficiency; AND 3) Planning and conducting comprehensive projects or studies outlining proposed recommendations based on findings. 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/12803707
Develop and coordinate the work of program task forces and work groups on cross program issues and problems and present impact analysis and recommendations to senior MPMG/MCSG, DHPO and OPOLE managers.
Conduct studies to ensure consistency and the elimination of unnecessary duplication of effort and cost between program activities.
Perform or lead national studies, reviews, evaluations, and/or projects that directly impact upon Group’s Medicare program area(s) across the country.
Analyze and implement methods for ensuring that uniform application of program policies and regulations is consistent throughout the Group.
Participate in and make key authoritative contributions to top-level discussions and planning sessions on Medicare program policy development. Coordinate and follow up on assignments in the management and administration of work projects.


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