Serve as the principal authority on claims oversight and audit integrity within the TRICARE Overseas Program Office (TOPO).
Lead the development and execution of audit protocols to ensure compliance with TRICARE policies, Defense Health Agency (DHA) regulations, and international agreements.
Provide strategic policy analysis, program evaluation, and technical guidance on TRICARE Overseas health benefit delivery system.
Develop recommendations for legislative amendments, regulatory changes, and procedural improvements affecting overseas healthcare delivery and claims operations.
Monitor key claims metrics such as payment accuracy, denial rates, and turnaround times, and develops strategies to prevent fraud, waste, and abuse.
Collaborate with contractors, providers, and DoD stakeholders to resolve complex disputes and improve adjudication accuracy.
Serve as a senior advisor and spokesperson for DHA, ASD(HA), and USD(P and R) executive leadership on matters related to TRICARE Overseas claims processing, program integrity, and managed care policy.
Develop and articulates DHA’s position on healthcare procurement, claims compliance, and policy initiatives.
Appointment may be subject to a suitability or fitness determination, as determined by a completed background investigation.
This position requires the incumbent be able to obtain and maintain a determination of eligibility for a Secret security clearance or access for the duration of employment. A background investigation and credit check are required.
Qualifications
Who May Apply: Only applicants who meet one of the employment authority categories below are eligible to apply for this job. You will be asked to identify which category or categories you meet, and to provide documents which prove you meet the category or categories you selected.
Current Civilian Employees of the Defense Health Agency (DHA)
Interagency Career Transition Assistance Plan
Land Management Workforce Flexibility Act
Military Spouses, under Executive Order (E.O.) 13473
Priority Placement Program, DoD Military Reserve (MR) and National Guard (NG) Technician Eligible
Priority Placement Program, DoD Military Spouse Preference (MSP) Eligible
Priority Placement Program, DoD MR and NG Preference Eligible Tech Receiving Disability Retirement
Priority Placement Program, DoD Retained Grade Preference Eligible
Veterans Employment Opportunity Act (VEOA) of 1998
In order to qualify, you must meet the experience requirements described below. 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). You will receive credit for all qualifying experience, including volunteer experience. Your resume must clearly describe your relevant experience; if qualifying based on education, your transcripts will be required as part of your application. Additional information about transcripts is in this document.
Basic Requirements for Program Analyst GS-0343-13:
Specialized Experience: One year of specialized experience which includes; analyzing health policy issues to make recommendations for improvement, preparing audit reports to recommend corrective actions and assisting senior representatives in improving the claims process systems and/or audit functions. This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GS-12).
Some federal jobs allow you to substitute your education for the required experience in order to qualify. For this job, you must meet the qualification requirement using experience alone--no substitution of education for experience is permitted.
Basic Requirements for Program Analyst GS-0343-14:
Specialized Experience: One year of specialized experience which includes; developing audit protocols to ensure compliance with organizational policies, providing guidance on health benefit delivery systems for improvement and advising on complex issues pertaining to the implementation of health care programs. This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GS-13).
Some federal jobs allow you to substitute your education for the required experience in order to qualify. For this job, you must meet the qualification requirement using experience alone--no substitution of education for experience is permitted.
You will be evaluated on the basis of your level of competency in the following areas:
Planning and Evaluating
Problem Solving
Strategic Thinking
Time in Grade Requirement for GS-13 Grade level: Applicants who have held a General Schedule (GS) position within the last 52 weeks must have 52 weeks of Federal service at the next lower grade or equivalent (GS-12).
Time in Grade Requirement for GS-14 Grade level: Applicants who have held a General Schedule (GS) position within the last 52 weeks must have 52 weeks of Federal service at the next lower grade or equivalent (GS-13).
Education
This job does not have an education qualification requirement.
Additional information
Male applicants born after December 31, 1959 must complete a Pre-Employment Certification Statement for Selective Service Registration.
You will be required to provide proof of U.S. Citizenship.
One year trial/probationary period may be required.
Direct Deposit of Pay is required.
Selection is subject to restrictions resulting from Department of Defense referral system for displaced employees.
Multiple positions may be filled from this announcement.
Salary includes applicable locality pay or Local Market Supplement.
If you have retired from federal service and you are interested in employment as a reemployed annuitant, see the information in the Reemployed Annuitant information sheet.
Payment of Permanent Change of Station (PCS) costs is not authorized, based on a determination that a PCS move is not in the Government interest.
Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution.
You will be evaluated for this job based on how well you meet the qualifications above.
Once the announcement has closed, a review of your application package (resume, supporting documents, and responses to the questionnaire) will be used to determine whether you meet the qualification requirements listed on this announcement. If you are minimally qualified, your resume and supporting documentation will be compared against your responses to the assessment questionnaire to determine your level of experience. 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 when applying, errors or omissions may affect your eligibility.
You should list any relevant performance appraisals and incentive awards in your resume as that information may be taken into consideration during the selection process. If selected, you may be required to provide supporting documentation.
You may claim Military Spouse preference.
Military Spouse Preference (MSP) applicants will receive preference consideration and will be placed (if selected) at the highest grade for which they have applied and are determined best qualified, up to and including the full performance level.
You may claim Priority Placement Program (PPP) preference.
DoD Priority Placement Program (PPP) Applicants will receive preference consideration at the full-performance grade level only.
Interagency Career Transition Assistance Program (ICTAP). If you are a Federal employee in the competitive service and your agency has notified you in writing that you are a displaced employee eligible for ICTAP consideration, you may receive selection priority for this position. To receive selection priority, you must: (1) meet ICTAP eligibility criteria (2) be rated well-qualified for the position and; (3) submit the appropriate documentation to support your ICTAP eligibility. To be considered well-qualified and receive selection priority applicants must satisfy all qualification requirements for the position and receive a score of 90 or above. Additional information about the program is on OPM's Career Transition Resources website.
The documents you are required to submit vary based on the authority you are using to apply (i.e., applying as a veteran, applying as a current permanent Federal employee, applying as a reinstatement, etc). Please review the following links to see which documents you need to provide to prove your eligibility to apply: Applicant Checklist for Internal/MP Announcements (DoD)
As described above, your complete application includes your resume, your responses to the online questionnaire, and documents which prove your eligibility to apply. If you fail to provide these documents, you will be marked as having an incomplete application package and you will not be considered any further.
1. Your resume:
Your resume may be submitted in any format and must support the specialized experience described in this announcement.
If your resume includes a photograph or other inappropriate material or content, it will not be used to make eligibility and qualification determinations and you may not be considered for this vacancy.
For qualifications determinations your resume must contain hours worked per week and the dates of employment (i.e., HRS per week and month/year to month/year or month/year to present). If your resume does not contain this information, your application may be marked as incomplete and you may not receive consideration for this position.
Proof of Eligibility to Apply: Your application must include the documents which prove you are eligible to apply for the vacancy. The Proof of Eligibility document describes authorities commonly used in merit promotion recruitment and what document(s) are required to prove you meet the requirements of the authority. You must meet the requirements of at least one of the authorities listed in the Who May Apply section above to receive further consideration.
Time-in-grade documentation: If you are applying for a higher grade and your SF-50 has an effective date within the past year, it may not clearly demonstrate you meet the one year time-in-grade requirement so you will need to provide an SF-50 which clearly demonstrates you meet the time-in-grade requirements (examples of appropriate SF-50s include Promotions, Within-grade Grade/Range Increases, and SF-50s with an effective date more than one year old).
NOTE: Documents submitted as part of the application package, to include supplemental documents, may be shared beyond the Human Resources Office. Some supplemental documents such as military orders and marriage certificates may contain personal information for someone other than you. You may sanitize these documents to remove another person's personal information before you submit your application. You may be asked to provide an un-sanitized version of the documents if you are selected to confirm your eligibility.
To apply for this position, you must complete the online questionnaire and submit the documentation specified in the Required Documents section below.
The complete application package must be submitted by 11:59 PM (EST) on 09/16/2025to receive consideration.
To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application (https://apply.usastaffing.gov/ViewQuestionnaire/12797955).
Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application. You must re-select your resume and/or other documents from your USAJOBS account or your application will be incomplete.
It is your responsibility to verify that your application package (resume, supporting documents, and responses to the questionnaire) is complete, accurate, and submitted by the closing date. Uploaded documents may take up to one hour to clear the virus scan.
Additional information on how to complete the online application process and submit your online application may be found on the USA Staffing Applicant Resource Center.
To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.
KF-DDAAFC DHA HQs
DO NOT MAIL
Falls Church, VA 22042
US
Next steps
If you provided an email address, you will receive an email message acknowledging receipt of your application. Your application package will be used to determine your eligibility, qualifications, and quality ranking for this position. If you are determined to be ineligible or not qualified, your application will receive no further consideration.
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
The documents you are required to submit vary based on the authority you are using to apply (i.e., applying as a veteran, applying as a current permanent Federal employee, applying as a reinstatement, etc). Please review the following links to see which documents you need to provide to prove your eligibility to apply: Applicant Checklist for Internal/MP Announcements (DoD)
As described above, your complete application includes your resume, your responses to the online questionnaire, and documents which prove your eligibility to apply. If you fail to provide these documents, you will be marked as having an incomplete application package and you will not be considered any further.
1. Your resume:
Your resume may be submitted in any format and must support the specialized experience described in this announcement.
If your resume includes a photograph or other inappropriate material or content, it will not be used to make eligibility and qualification determinations and you may not be considered for this vacancy.
For qualifications determinations your resume must contain hours worked per week and the dates of employment (i.e., HRS per week and month/year to month/year or month/year to present). If your resume does not contain this information, your application may be marked as incomplete and you may not receive consideration for this position.
Proof of Eligibility to Apply: Your application must include the documents which prove you are eligible to apply for the vacancy. The Proof of Eligibility document describes authorities commonly used in merit promotion recruitment and what document(s) are required to prove you meet the requirements of the authority. You must meet the requirements of at least one of the authorities listed in the Who May Apply section above to receive further consideration.
Time-in-grade documentation: If you are applying for a higher grade and your SF-50 has an effective date within the past year, it may not clearly demonstrate you meet the one year time-in-grade requirement so you will need to provide an SF-50 which clearly demonstrates you meet the time-in-grade requirements (examples of appropriate SF-50s include Promotions, Within-grade Grade/Range Increases, and SF-50s with an effective date more than one year old).
NOTE: Documents submitted as part of the application package, to include supplemental documents, may be shared beyond the Human Resources Office. Some supplemental documents such as military orders and marriage certificates may contain personal information for someone other than you. You may sanitize these documents to remove another person's personal information before you submit your application. You may be asked to provide an un-sanitized version of the documents if you are selected to confirm your eligibility.
To apply for this position, you must complete the online questionnaire and submit the documentation specified in the Required Documents section below.
The complete application package must be submitted by 11:59 PM (EST) on 09/16/2025to receive consideration.
To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application (https://apply.usastaffing.gov/ViewQuestionnaire/12797955).
Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application. You must re-select your resume and/or other documents from your USAJOBS account or your application will be incomplete.
It is your responsibility to verify that your application package (resume, supporting documents, and responses to the questionnaire) is complete, accurate, and submitted by the closing date. Uploaded documents may take up to one hour to clear the virus scan.
Additional information on how to complete the online application process and submit your online application may be found on the USA Staffing Applicant Resource Center.
To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.
KF-DDAAFC DHA HQs
DO NOT MAIL
Falls Church, VA 22042
US
Next steps
If you provided an email address, you will receive an email message acknowledging receipt of your application. Your application package will be used to determine your eligibility, qualifications, and quality ranking for this position. If you are determined to be ineligible or not qualified, your application will receive no further consideration.
Fair and transparent
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
