This Position Is No Longer Available
  1. Overview
  2. Duties
  3. Qualifications & Evaluations
  4. Benefits & Other Info
  5. How to Apply

Job Title:HEALTH INSURANCE SPECIALIST

Department:Department Of Health And Human Services

Agency:Centers for Medicare & Medicaid Services

Job Announcement Number:CMS-CMHPO-DE-13-841736

This position is closed and no longer accepting online applications through USAJOBS.

The contents of the announcement can still be viewed.

SALARY RANGE:

$50,154.00 to $94,551.00 / Per Year

OPEN PERIOD:

Friday, February 15, 2013 to Monday, March 04, 2013

SERIES & GRADE:

GS-0107-09/12

POSITION INFORMATION:

Full Time - Permanent

PROMOTION POTENTIAL:

12

DUTY LOCATIONS:

1 vacancy in the following location:
Dallas, TX United StatesView Map

WHO MAY APPLY:

United States Citizens

JOB SUMMARY:

Become a part of the Department that touches the lives of every American! At the Department of Health and Human Services (HHS) you can give back to your community, state, and country by making a difference in the lives of Americans everywhere. It is the principal agency for protecting the health of citizens. Join HHS and help to make our world healthier, safer, and better for all Americans.

The Centers for Medicare and Medicaid Services (CMS) works in partnership with the entire health care community to improve quality and efficiency in an evolving health care system and provides leadership in the broader health care marketplace. Our effectiveness depends on the capabilities of a dedicated, professional staff that is committed to supporting these objectives. A career with CMS offers the opportunity to get involved on important national health care issues and be part of a dynamic, fast-paced, and highly visible organization. 


For more information on CMS, please see: https://www.cms.gov/

 

WHO MAY APPLY: This is a competitive vacancy, open to all United States Citizens or Nationals, advertised under Delegated Examining Authority. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would therefore be given new appointments to the civil service; however, benefits, time served and all other Federal entitlements would remain the same. Click here for more information about US Citizenship and other eligibility information .


This vacancy is also being announced concurrently with vacancy announcement CMS-CMHPO-MP-13-838634 under merit promotion procedures.  Please review that announcement to see if you are eligible for consideration under merit promotion procedures. NOTE: Applicants who wish to be considered under both announcements, must apply separately for each in order to be considered.


Additional selections may be made from this announcement for similar positions within CMS in the same geographical location.

 

This position is located in the Centers of Medicare & Medicaid Services, Regional Consortium Administrator for Medicare Health Plans Operations in Dallas, TX.

 

KEY REQUIREMENTS

  • You must be a U.S. Citizen or National to apply for this position.
  • You must meet the Selective Service requirements (See “Other Information”).
  • You must complete the questionnaire and/or knowledge, skills and abilities.
  • A one-year probationary period MAY be required.
  • Use the Print Preview feature for a complete copy of this announcement.

DUTIES:

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In this position you will serve as a Health Insurance Specialist located  in the Centers of Medicare and Medicaid Services (CMS), Consortium of Medicare Health Plans Operations, Division of Medicare Health Plans Operations (DMHPO), in a Regional Office performing a a full range of activities for assigned areas of Medicare Advantage (MA) and/or Medicare Health Plans (MHPs) to ensure that the MA/MHP programs result in appropriate and adequate levels of medical services delivery to Medicare enrollees.  

Specifically, you will: 

 

·          Perform scheduled audits and provide ongoing monitoring of compliance with Federal and CMS   

        guidance to ensure continuing compliance with the Medicare contract all all statutory and regulatory

        requirements.

·          Prepare report of findings, enters findings and develops recommendations, proving input for  

        development of corrective action.

·         Gather and analyze information for ongoing operations of the organization and initiate appropriate

       action when follow-up is indicated. 

·         Review corrective action plan and participate in the development of the response and ongoing

       monitoring of the plan through execution.  

·         Received, review and respond to complaints and identifies issues requiring resolution.  

·         Develop written reports and present information clearly, concisely and effectively.

 


QUALIFICATIONS REQUIRED:

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A determination of your minimum qualifications will be based on the requirements listed below.  You will be evaluated based upon the experience and/or education reflected in your resume.  Please use clear and concise descriptions/examples when describing your experience.  Applicants are advised that all information concerning qualifications is subject to investigation.  By submitting your application, you are certifying the accuracy of the information contained in your application.  If you make a false statement in any part of your application, you may not be hired; you may be terminated after you begin work; or, you may be fined or jailed. ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.

 

Specialized Experience: Specialized Experience is experience that has equipped the applicant with the particular knowledge, skills, and abilities to perform successfully the duties of the position and is typically in or related to the work of the position to be filled.

 

 

For the GS-9 Grade Level: Specialized experience is defined as one (1) year (52 weeks) of specialized experience equivalent to the grade 7 level in the Federal service obtained in either the private or public sector, which includes:  Responding to telephone and written inquiries from beneficiaries regarding Medicare Advantage and Medicare Health Plans. Gathering and analyzing operations information and initiates appropriate action when follow-up is needed, knowledge of Medicare Advantage and/or Medicare Health Plan programs such as marketing, enrollment/eligibility, appeals and all Medicare operations areas.

 

- OR - Substitution of Education for Experience:  You may substitute education for specialized experience at the GS 9 level by possessing a Master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., 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-7 grade level may be used to qualify applicants for positions at grades GS-9. Therefore, only education in excess of 1 full year of graduate level education may be used to combine education and experience. 

 

TRANSCRIPTS are required 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.


Time in Grade:
To be eligible, current Federal employees applying for this position must have served at least one (1) year (52 weeks) at the GS-7 grade level.

 

For the GS-11 Grade Level: Specialized experience is defined as one (1) year (52 weeks) of specialized experience equivalent to the grade 9 level in the Federal service obtained in either the private or public sector, which includes: Identifying issues, and develops recommendation reports  related to  the approval/denial of Medicare Advantage and Medicare Health Plans. Knowledge of Health Plan programs such as marketing, enrollment/eligibility, appeals and all Medicare operations areas.

 

- OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS 11 level by possessing 3 full years of progressively higher level graduate education leading to such a degree or Ph.D. 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-9 grade level may be used to qualify applicants for positions at grades GS-11. Therefore, only education in excess of a master's or equivalent graduate degree; 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 substitution of education for experience and combination of education and experience. Please see "REQUIRED DOCUMENTS" section below on what documentation is required.


Time in Grade:
To be eligible, current Federal employees applying for this position must have served at least one (1) year (52 weeks) at the GS-9 grade level.

For the GS-12 Grade Level:   Specialized experience is defined as one (1) year (52 weeks) of specialized experience equivalent to the grade 11 level in the Federal service obtained in either the private or public sector, which includes: Assuring all of Medicare Advantage and/or Medicare Health Plan organizations in the region comply with their contracts, and regulatory requirements; analyzing and evaluating complex studies and projects; and developing written reports and presenting information clearly, concisely, and effectively. Formulates and develops recommendations for changes to existing or proposed program policies, manuals, regulatory requirements and legislation.

 

Substitution of Education for Experience: There is no substitution of education for specialized experience at this grade level.

Combination of Experience and Education:  There is no combination of experience and education for this grade level.

 


Foreign Education: If you are using education completed in foreign colleges or universities to meet the qualification requirements, additional supporting documentation is required. Click here for more information about REQUIRED DOCUMENTS.

Conditions of Employment:

 

1. Security and Background Requirements: If not previously completed, a background security investigation will be required for all appointees. Appointment will be subject to the applicant's successful completion of a background security investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a background security reinvestigation or supplemental investigation may be required at a later time. Applicants are also advised that all information concerning qualifications is subject to investigation. False representation may be grounds for non-consideration, non-selection and/or appropriate disciplinary action.

·    Optional Form 306 – Declaration of Federal Employment – available at http://www.opm.gov/forms/pdf_fill/of306.pdf. This form is not required to be submitted at the time of submitting your application. However, if selected, this form will be required prior to final job offer.

2. E-Verify: If you are selected for this position, the documentation that you present for purposes of completing the Department of Homeland Security (DHS) Form I-9 will be verified through the DHS "E-Verify" System. Federal law requires DHS to use the E-Verify System to verify employment eligibility of all new hires, and as a condition of continued employment obligates the new hire to take affirmative steps to resolve any discrepancies identified by the system. The U.S. Department of Health and Human Services is an E-Verify Participant.

3. Direct Deposit: All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choosing.

HOW YOU WILL BE EVALUATED:

Once the application process is complete, a review of resume and supporting documentation will be made and compared against your responses to the assessment questionnaire to determine if you are qualified for this job.  If, after reviewing your resume and or supporting documentation, a determination is made that you have inflated your qualifications and or experience, you may lose consideration for this position.  Please follow all instructions carefully. Errors or omissions may affect your eligibility.  Category rating procedures will be used to rate and rank candidates. The category assignment is a measure of the degree in which your background matches the competencies required for this position. Qualified candidates will be ranked into one of three categories: Best Qualified, Well Qualified or Qualified.

 

The Category Rating Process does not add veterans’ preference points but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent must be listed in the highest quality category (except in the case of scientific or professional positions at the GS-9 level or higher).

 

Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):

 

·   ANALYTICAL

·   REGULATORY & PROGRAM PREQUIREMENTS 

·   ORAL COMMUNICATION 

·   PROBLEM SOLVING 

 

  •  

    Your résumé and/or supporting documentation will be verified.   Please follow all instructions carefully. Errors or omissions may affect your rating or consideration for employment.

     

    NOTE: If you submit a resume but no questionnaire, you will not be considered for the position. If you submit a questionnaire but no resume, you cannot be considered for the position. Your application will be appropriately documented and you will be removed from competition.


    BENEFITS:

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    The Federal government offers a number of exceptional benefits to its employees. The following links are provided for your reference to explore the major benefits offered to most Federal employees: http://www.usajobs.gov/ResourceCenter/Index/Interactive/Benefits#icc

    Flexible Spending Accounts -  https://www.fsafeds.com/fsafeds/index.asp

    Health Insurance - http://www.opm.gov/insure/health/index.asp 

    Leave -  http://www.opm.gov/oca/leavel/index.asp
    Life Insurance -
      http://www.opm.gov/insure/life/index.asp
    Long Term Care Insurance -
    http://www.ltcfeds.com/

    Retirement Program -   http://www.opm.gov/retire/index.asp



    OTHER INFORMATION:

    WORK SCHEDULE: Full Time

    TRAVEL REQUIREMENT: May be Required

    TOUR OF DUTY: Flexible

    FAIR LABOR STANDARDS ACT: Exempt

    RELOCATION EXPENSES (PCS): Not Authorized

    RECRUITMENT INCENTIVE: May Be Authorized

    SECURITY REQUIREMENTS: Enter Appropriate Data

    FINANCIAL DISCLOSURE: May Be Required

    BARGAINING UNIT POSITION:  Yes

    JOB CODE:  H68340

    TRANSCRIPTS or COURSE LISTINGS: Required ONLY if substituting education for specialized experience.  

    NOTE:  An unofficial transcript or a list of courses, grades earned, completion dates, and quarter and semester hours earned can be used as a substitute for the official transcript at the time the person applies for a job opening.

     

    DISPLACED FEDERAL EMPLOYEES: If you are a displaced Federal Employee, you may be eligible for priority consideration under the Interagency Career Transition Assistance Plan (ICTAP). Please visit this link to obtain requirements for applying as an ICTAP eligible applicant    http://www.opm.gov/rif/employee_guides/career_transition.asp#ictap. If you feel as though you are eligible under the ICTAP program, please see the "REQUIRED DOCUMENTS" sections below. Candidates must meet or exceed the Well Qualified category to be considered for this vacancy as an ICTAP eligible.

     

    VETERANS' PREFERENCE: If you are a veteran with preference eligibility and you are claiming 5-points veterans' preference, you must submit a copy of your DD-214 or other proof of eligibility. If you are claiming 10-point veterans' preference, you must also submit an SF-15, "Application for 10-Point Veterans' Preference" plus the proof required by that form. Documentation intended to establish preference must be received by 11:59PM EST on the closing date of this announcement. Information on veterans' preference and other veteran entitlements can be found in the VetInfo Guide:  http://www.opm.gov/staffingportal/vetguide.asp

     

    JOB SEEKERS WITH DISABILITIES: Federal agencies fill jobs two ways, competitively and non-competitively. Persons with disabilities may apply for jobs filled either way. People who are selected for jobs must meet the qualification requirements and any education requirements for the jobs and be able to perform the essential duties of the jobs with or without reasonable accommodation. For information, please visit http://opm.gov/disability/PeopleWithDisabilities.asp

     

    SELECTIVE SERVICE: MALE APPLICANTS BORN AFTER 12/31/1959 must certify prior to job offer that they have registered with the Selective Service System, or are exempt from having to do so under Selective Service law. https://help.usajobs.gov/index.php/Registering_with_the_Selective_Service_before_you_apply



    HOW TO APPLY:

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    To begin the process, click the Apply Online button to create an account or log in to your existing USAJOBS account.  Follow the prompts to complete the assessment questionnaire.  Please ensure you click the Submit My Answers button at the end of the process.

     

    Note: To return to a previously Saved or Incomplete application you may use the following link: https://applicationmanager.gov/ .

     

    To fax supporting documents you are unable to upload, complete this cover page http://staffing.opm.gov/pdf/usascover.pdf using the following vacancy 841736.  Fax your documents to 1-478-757-3144.

     

    If you cannot apply online:

     

    1. Click the following link to view and print the assessment questionnaire View Occupational Questionnaire; and 

     

    2. Print this 1203FX form to provide your response to the assessment questionnaire http://www.opm.gov/forms/pdf_fill/OPM1203fx.pdf; and

     

    3. Fax the completed 1203FX form along with any supporting documents to 1-478-757-3144.  Your 1203FX will serve as a cover page for your fax transmission.

     

    4. This agency provides reasonable accommodation to applicants with disabilities.  If you need a reasonable accommodation for any part of the application and hiring process, please contact the CMS HelpDesk at 1(888)423-2737 or (410)786-3936 TTY/TDD: (410)786-0270; or by email HRCenterHelpdesk@cms.hhs.gov. The decision on granting reasonable accommodation will be made on a case-by-case basis.

     

    NOTE: Submission of a résumé alone IS NOT a complete application. This position requires the completion of additional forms and/or supplemental materials as described under the "REQUIRED DOCUMENTS" section of this announcement. Please carefully review the complete job announcement and the "How to Apply" instructions. Failure to provide the required information and/or materials will result in you not being considered for employment.



    REQUIRED DOCUMENTS:

    The following documents are required:
     
    1.  Resume showing relevant experience; cover letter optional.  Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59.  Your resume should also list your educational and work experience including the dates (mm/dd/yy) of each employment along with the number of hours worked per week.  For work in the Federal service, please include the grade level for the position(s).  Your resume may be used to validate your responses to the assessment tool(s). 
     
    For Résumé and Application Tips visit:
    http://www.usajobs.gov/ResourceCenter/Index/Interactive/ResumeAndApplicationTips#icc
     
    2.  A complete Assessment Questionnaire
    3.
     
    Supplemental Documents, if applicable (i.e., SF-50, DD-214, SF-15 etc).
     
    Supplemental documents may be required in the vacancy announcement.   Failure to provide appropriate documentation MAY result in a not qualified rating OR non-consideration. Click here for a detailed description of the REQUIRED DOCUMENTS. 
     
    You will be required to submit official documentation prior to appointment.  The agency will then verify the information provided on your application (i.e., degree, veterans' preference, disability, etc.).

    The complete Application Package (including all required documents) must be submitted by 11:59 PM (EST) on Monday, February 25, 2013.

     

    Contact Information: CMS HR Center Helpdesk
    Phone: 1-888-423-2737 or 410-786-3936
    TDD: (410)786-0270
    Email:
    HRCenterHelpdesk@cms.hhs.gov

    Hours of Operation: Monday - Friday from 8:00AM ET to 5:00PM ET (excludes all Federal holidays) 

    AGENCY CONTACT INFO:

    CMS HR Center Helpdesk
    Phone: (888)423-2737
    Email: HRCENTERHELPDESK@CMS.HHS.GOV
    Agency Information:
    HHS CMS Center
    7500 Security Blvd
    Mailstop C4-14-15
    Baltimore, MD
    21244

    WHAT TO EXPECT NEXT:

    Once the online questionnaire is received you will receive an acknowledgement email that your submission was successful.  The most highly qualified candidates will be referred to the hiring manager for further consideration and possible interview.  We expect to make a selection within 45 days of the closing date of this announcement.

    You will receive notice via email or by mail, if no email address was provided by you during the application process, once this process is completed (generally 4-6 weeks).


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    Job Announcement Number:

    CMS-CMHPO-DE-13-841736

    Control Number:

    337764700