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Health Insurance Specialist (Program Policy)

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Office of the Administrator (OA)
This job announcement has closed

Summary

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.

Overview

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Reviewing applications
Open & closing dates
09/19/2025 to 09/25/2025
Salary
$107,103 to - $156,755 per year

Please see the Additional Information section for further salary information.

Pay scale & grade
GS 13
Locations
50 vacancies in the following locations:
Denver, CO
Atlanta, GA
Boston, MA
Woodlawn, MD
Remote job
No
Telework eligible
Yes—as determined by the agency policy.
Travel Required
Occasional travel - You may be expected to travel up to 5% for this position.
Relocation expenses reimbursed
No
Appointment type
Permanent
Work schedule
Full-time
Service
Competitive
Promotion potential
13
Supervisory status
No
Security clearance
Not Required
Drug test
No
Position sensitivity and risk
Moderate Risk (MR)
Trust determination process
Financial disclosure
No
Bargaining unit status
Yes
Announcement number
CMS-OA-25-12802897-DE
Control number
846371200

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Duties

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  • 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.

Requirements

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Conditions of employment

  • You must be a U.S. Citizen or National to apply for this position.
  • You will be subject to a background and suitability investigation.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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 consequence

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.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/12802897

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: Yes-American Federation of Government Employees, Local 1923
Tour of Duty: Flexible
Recruitment Incentive: Not Authorized
Relocation Incentive: Not Authorized
Financial Disclosure: Not Required

Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement. CMS offers flexible working arrangements and allows employees the opportunity to participate in alternative work schedules at the manager's discretion.

The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.

Additional Salary Information:
Atlanta: $111,442 to $144,876
Boston: $119,355 to $155,164
Dallas: $114,566 to $148,937
Denver: $117,501 to $152,753
Kansas City: $107,103 to $139,235
Philadelphia: $116,123 to $150,962
Seattle: $118,446 to $153,982
Woodlawn: $120,579 to $156,755

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.

How you will be evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), the responses you provide on the application questionnaire, and the result of the online assessments required for this position. Please follow all instructions carefully. Errors or omissions may affect your rating.

You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics):
Accountability
Customer Service
Decisiveness
Flexibility
Interpersonal Skills
Problem Solving
Resilience

In order to be considered for this position, you must complete all required steps in the process. In addition to the application and application questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job.

Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on the online assessment may also result in your removal from consideration.

You will be placed in one of the following categories based on category rating and selection procedures if you meet all of the requirements outlined in this job opportunity announcement:

  • Best Qualified - for those who are superior in the evaluation criteria
  • Well Qualified - for those who excel in the evaluation criteria
  • Qualified - for those who only meet the minimum qualification requirements

If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration.

This is a competitive vacancy announcement 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.

The category rating process does not add veterans' preference points or apply the "rule of three" but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans' preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher).

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