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Health Insurance Specialist

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Medicaid and CHIP Services

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicaid and CHIP Services (CMCS).

As a Health Insurance Specialist, GS-0107-13, you will serve as an expert in the development, evaluation, and implementation of policies related to Medicaid, Children's Health Insurance Program (CHIP), and Basic Health Program (BHP) policies.

Overview

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Accepting applications
Open & closing dates
03/06/2026 to 03/12/2026
Salary
$108,173 to - $158,322 per year

Locality pay rate will be contingent on the duty station selected.

Pay scale & grade
GS 13
Locations
19 vacancies in the following locations:
Denver, CO
Atlanta, GA
Woodlawn, MD
Kansas City, MO
Remote job
No
Telework eligible
Yes—as determined by the agency policy.
Travel Required
Occasional travel - You may be expected to travel 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-CMCS-26-12900704-DH
Control number
860010400

This job is open to

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Clarification from the agency

This announcement is advertised under Direct Hire Authority and is open to all United States Citizens.

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Duties

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  • Identify and propose modifications to Medicaid, CHIP, and BHP program measures, regulations, laws, and policies to reflect changes or trends in the health care industry, program objectives, and the needs of Medicaid, CHIP, and BHP beneficiaries.
  • Conduct analysis of policy issues and topics by researching background information, the origin of laws, and the intended impact to make effective policy recommendations.
  • Evaluate and analyze the impact of new or revised changes to legislation before the Congress pertaining to mentioned programs.
  • Research all program issues and develop the appropriate response that includes CMS regulations, or policy issuances.
  • Analyze internal policies, processes, and procedures to assure increased efficiency in operations and implements them to resolve problems and improve internal operations.

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 (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 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) Implementing program policies related to Medicaid, CHIP, or the Basic Health Program to ensure compliance with federal regulations and program objectives;
2) Developing regulations, manuals, program guidelines, program memoranda, policy letters, or instructions to communicate health insurance program policies; AND
3) Presenting recommendations based on the evaluation of health insurance programs that describe feasible options or the consequences.

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/12900704

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: 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.

Salary by Locatity:
Atlanta: $112,556 - $146,325
Denver: $118,675 - $154,280
Kansas City: $108,173 - $140,627
Philadelphia: $117,284 - $152,471
Woodlawn: $121,785 - $158,322

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.

Traditional rating and ranking of applications does not apply to this vacancy. Applications will be evaluated against the basic qualifications. Qualified candidates will be referred for consideration in accordance with the Office of Personnel Management direct hire guidelines. Veterans' Preference does not apply to direct hire recruitment procedures. 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.

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