This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI) or Center for Consumer Information and Insurance Oversight (CCIIO).
As a Health Insurance Specialist (Program Integrity), referred to here as Program Integrity Analyst (Health Insurance), GS-0107-13, you will develop, evaluate, and implement a wide range of program integrity initiatives and reviews to support CMS' lines of business.
Summary
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI) or Center for Consumer Information and Insurance Oversight (CCIIO).
As a Health Insurance Specialist (Program Integrity), referred to here as Program Integrity Analyst (Health Insurance), GS-0107-13, you will develop, evaluate, and implement a wide range of program integrity initiatives and reviews to support CMS' lines of business.
Review and evaluate financial program payments, identify areas of potential non-compliance, investigate fraud, waste, and abuse allegations, and conduct thorough program integrity reviews to safeguard Agency programs.
Review and comment on new or proposed policy revisions, regulations, administrative sanctions, and legislation to determine their impact on contractor/provider operations and program safeguarding effectiveness.
Study healthcare financing or delivery systems data and conduct complex analytical projects involving coordination across organizational lines.
Establish and maintain effective working relationships with diverse contacts including State officials, government agency representatives, and healthcare industry officials.
Apply extensive knowledge of Titles XVIII and XIX of the Social Security Act, healthcare laws (including Title XVII of the Public Health Service Act), and regulations to make recommendations for improving program operations.
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 (limited to no more than 2 pages) 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 being considered further.
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) Evaluating health insurance program vulnerabilities to detect fraud, waste, or abuse;
2) Collaborating across organizational lines on investigations, audits, or oversight of health insurance programs; AND
3) Proposing policy changes relating to program integrity.
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.
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.
For more information on locality and pay scales, please click here. https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/
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.
A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.
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 results of the online assessments required for this position. A Subject Matter Expert may assist in the resume review process to help determine whether you meet the minimum job qualifications. 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
Attention to Detail
Customer Service
Decisiveness
Flexibility
Integrity/Honesty
Interpersonal Skills
Learning
Problem Solving
Resilience
Self-Management
Stress Tolerance
Teamwork
Decision Making
Reading Comprehension
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).
A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.
To apply for this position, you must submit a complete Application Package which includes:
1. Resume showing relevant experience; cover letter optional.NOTE: As of September 27, 2025, federal agencies will only accept resumes that are two pages or less in length.Your resume must indicate your citizenship and whether you are registered with the Selective Service if you are a male born after December 31, 1959. Your resume must also list your work experience and education (if applicable), including the start and end dates (mm/yyyy) of each employment, along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). For resume and application tips, visit: https://help.usajobs.gov/faq/application/documents/resume/what-to-include.
Your resume will be used to validate your responses to the assessment tool(s). We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Determining length of general or specialized experience is dependent on the information provided in the resume. Failure to include ALL of the information listed below on your resume WILL result in a finding of ineligible.
Official Position Title (include series and grade if Federal job)
Duties (be specific in describing your duties)
Employer's name and address
Supervisor name and phone number
Start and end dates in the month and year format (e.g. June 2007 to April 2008)
Full-time or part-time status (include hours worked per week)
Salary
2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.
3. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended, that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency-Based Assessments and appropriate supporting documentation for RA must be received prior to commencing the USA Hire Competency-Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency-Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency-Based Assessments if you received the link after the close of the announcement. To determine if you need an RA, please click here to review the Procedures for Requesting a Reasonable Accommodation for Online Assessments.
4. RPL Eligibility Required Documents: The following documents are required to verify your RPL eligibility: 1) Your most recent SF-50 (Notification of Personnel Action), or equivalent, as stated in the job announcement that shows position occupied (block #34 of your SF-50), tenure, grade and step, salary, and full performance level; 2) Your SF-50 showing Separation - RIF. If that is not available yet, then official documentation of your Reduction in Force (RIF) separation notice or a proposed removal/separation notice; AND3) Your latest performance rating and rating of record (if separate documents) showing your rating score as at least fully successful or equivalent.
Please read the entire announcement and all the instructions before you begin an application. To apply and be considered for this position, you must complete all required questionnaires, assessments and submit all required documentation as specified in the How to Apply and Required Documents sections. The complete application package must be submitted by 11:59 PM (ET) on 02/02/2026. The application process is as follows:
Click the Apply button.
Answer the questions presented in the application and attach all necessary supporting documentation.
Click the Submit Application button prior to 11:59 PM (ET) on 02/02/2026.
If you are required to complete any USA Hire Assessments, you will be notified after submitting your application. The notification will be provided in your application submission screen and via email. The notification will include your unique assessment access link to the USA Hire system and the completion deadline. Additionally, in USAJOBS you can click "Track this application" to return to your assessment completion notice.
Access USA Hire using your unique assessment link. Access is granted through your USAJOBS login credentials.
Review all instructions prior to beginning your assessments. You will have the opportunity to request a testing accommodation before beginning the assessments should you have a disability covered under the Rehabilitation Act of 1973 as amended.
Set aside at least 3 hours to take the USA Hire Assessments; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue later, you can re-use your unique assessment link.
Your responses to the USA Hire Assessments will be reused for one year (in most cases) from the date you complete an assessment. If future applications you submit require completion of the same assessments, your responses will be automatically reused.
To update your application, including supporting documentation: During the announcement open period, return to your USAJOBS account, find your application record, and click Edit my application. This option will no longer be available once the announcement has closed.
To view the announcement status or your application status: Visit https://help.usajobs.gov/how-to/application/status. Your application status page is where you can view your application status, USA Hire assessment completion status, and review your notifications sent by the hiring agency regarding your application.
Commissioned Corps Officers (including Commissioned Corps professionally boarded applicants) who are interested in applying to this position must send their 1-page cover letter and 2-page ONLY professional resume (not PHS Curriculum Vitae) to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The resume should specifically explain how you are qualified for this position and draw specific attention to your skills and experiences that demonstrate these qualifications. Also, send any transcripts, licenses, or certifications as requested in this announcement. Please send all documents in 1 PDF file. In the subject line of your e-mail, include only the Job Announcement Number. In the body of your e-mail, include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.
Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.
When the Department of Health and Human Services (HHS) completes its selections, the remaining list of qualified candidates may be shared with other federal agencies. You will have an opportunity to opt in if you would like your name, application material, and assessment results shared for consideration of employment with additional agencies. There is no guarantee of further consideration, and you can continue to explore other job opportunity announcements.
Center for Consumer Information and Insurance Oversight
7500 Security Blvd
Woodlawn, MD 21244
US
Next steps
Based on your application and your responses to the application questionnaire, you may be presented with instructions on how to access the USA Hire system to complete the online assessments. The online assessments must be completed within 48 hours following the close of this announcement. You will have the opportunity to request a testing accommodation for the assessment should you have a disability covered under the Americans with Disabilities Act (ADA).
Your assessment results will be kept on record for one year and used toward future positions for which you might apply that require the same assessments.
Within 30 business days of the closing date, [Close Date Data Insert], you may check your status online by logging into your USAJOBS account (https://login.usajobs.gov/Account/). We will update your status after each key stage in the application process has been completed.
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
To apply for this position, you must submit a complete Application Package which includes:
1. Resume showing relevant experience; cover letter optional.NOTE: As of September 27, 2025, federal agencies will only accept resumes that are two pages or less in length.Your resume must indicate your citizenship and whether you are registered with the Selective Service if you are a male born after December 31, 1959. Your resume must also list your work experience and education (if applicable), including the start and end dates (mm/yyyy) of each employment, along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). For resume and application tips, visit: https://help.usajobs.gov/faq/application/documents/resume/what-to-include.
Your resume will be used to validate your responses to the assessment tool(s). We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Determining length of general or specialized experience is dependent on the information provided in the resume. Failure to include ALL of the information listed below on your resume WILL result in a finding of ineligible.
Official Position Title (include series and grade if Federal job)
Duties (be specific in describing your duties)
Employer's name and address
Supervisor name and phone number
Start and end dates in the month and year format (e.g. June 2007 to April 2008)
Full-time or part-time status (include hours worked per week)
Salary
2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.
3. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended, that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency-Based Assessments and appropriate supporting documentation for RA must be received prior to commencing the USA Hire Competency-Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency-Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency-Based Assessments if you received the link after the close of the announcement. To determine if you need an RA, please click here to review the Procedures for Requesting a Reasonable Accommodation for Online Assessments.
4. RPL Eligibility Required Documents: The following documents are required to verify your RPL eligibility: 1) Your most recent SF-50 (Notification of Personnel Action), or equivalent, as stated in the job announcement that shows position occupied (block #34 of your SF-50), tenure, grade and step, salary, and full performance level; 2) Your SF-50 showing Separation - RIF. If that is not available yet, then official documentation of your Reduction in Force (RIF) separation notice or a proposed removal/separation notice; AND3) Your latest performance rating and rating of record (if separate documents) showing your rating score as at least fully successful or equivalent.
Please read the entire announcement and all the instructions before you begin an application. To apply and be considered for this position, you must complete all required questionnaires, assessments and submit all required documentation as specified in the How to Apply and Required Documents sections. The complete application package must be submitted by 11:59 PM (ET) on 02/02/2026. The application process is as follows:
Click the Apply button.
Answer the questions presented in the application and attach all necessary supporting documentation.
Click the Submit Application button prior to 11:59 PM (ET) on 02/02/2026.
If you are required to complete any USA Hire Assessments, you will be notified after submitting your application. The notification will be provided in your application submission screen and via email. The notification will include your unique assessment access link to the USA Hire system and the completion deadline. Additionally, in USAJOBS you can click "Track this application" to return to your assessment completion notice.
Access USA Hire using your unique assessment link. Access is granted through your USAJOBS login credentials.
Review all instructions prior to beginning your assessments. You will have the opportunity to request a testing accommodation before beginning the assessments should you have a disability covered under the Rehabilitation Act of 1973 as amended.
Set aside at least 3 hours to take the USA Hire Assessments; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue later, you can re-use your unique assessment link.
Your responses to the USA Hire Assessments will be reused for one year (in most cases) from the date you complete an assessment. If future applications you submit require completion of the same assessments, your responses will be automatically reused.
To update your application, including supporting documentation: During the announcement open period, return to your USAJOBS account, find your application record, and click Edit my application. This option will no longer be available once the announcement has closed.
To view the announcement status or your application status: Visit https://help.usajobs.gov/how-to/application/status. Your application status page is where you can view your application status, USA Hire assessment completion status, and review your notifications sent by the hiring agency regarding your application.
Commissioned Corps Officers (including Commissioned Corps professionally boarded applicants) who are interested in applying to this position must send their 1-page cover letter and 2-page ONLY professional resume (not PHS Curriculum Vitae) to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The resume should specifically explain how you are qualified for this position and draw specific attention to your skills and experiences that demonstrate these qualifications. Also, send any transcripts, licenses, or certifications as requested in this announcement. Please send all documents in 1 PDF file. In the subject line of your e-mail, include only the Job Announcement Number. In the body of your e-mail, include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.
Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.
When the Department of Health and Human Services (HHS) completes its selections, the remaining list of qualified candidates may be shared with other federal agencies. You will have an opportunity to opt in if you would like your name, application material, and assessment results shared for consideration of employment with additional agencies. There is no guarantee of further consideration, and you can continue to explore other job opportunity announcements.
Center for Consumer Information and Insurance Oversight
7500 Security Blvd
Woodlawn, MD 21244
US
Next steps
Based on your application and your responses to the application questionnaire, you may be presented with instructions on how to access the USA Hire system to complete the online assessments. The online assessments must be completed within 48 hours following the close of this announcement. You will have the opportunity to request a testing accommodation for the assessment should you have a disability covered under the Americans with Disabilities Act (ADA).
Your assessment results will be kept on record for one year and used toward future positions for which you might apply that require the same assessments.
Within 30 business days of the closing date, [Close Date Data Insert], you may check your status online by logging into your USAJOBS account (https://login.usajobs.gov/Account/). We will update your status after each key stage in the application process has been completed.
Fair and transparent
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
