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Health Insurance Specialist

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Medicare/Medicare Plan Payment Group

Summary

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

As a Health Insurance Specialist, GS-0107-15, you will serve as the senior policy advisor and technical expert for the Director of MPPG and is a technical authority and program expert for Medicare managed care, prescription drug plan, and/or private health insurance policy.

Overview

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Accepting applications
Open & closing dates
05/11/2026 to 05/15/2026
Salary
$126,384 - $164,301 per year

Locality pay will be determined after the selection of the duty location.

Pay scale & grade
GS 15
Locations
1 vacancy in the following locations:
Chicago, IL
Woodlawn, MD
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
15
Supervisory status
No
Security clearance
Not Required
Drug test
No
Position sensitivity and risk
High Risk (HR)
Trust determination process
Financial disclosure
Yes - OGE-450
Bargaining unit status
Yes
Announcement number
CMS-CM-26-12955129-IMP
Control number
868327600

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Duties

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  • Responsible for providing expert guidance to senior leadership and staff regarding the development and implementation of policies related to the Medicare Advantage program, the Medicare prescription drug benefit, or drug pricing.
  • Represents the Staff and/or Center at briefings, hearings and other meetings throughout CMS and at other levels in government regarding the development and justification of payment policies for Medicare Advantage and Part D organizations.
  • Provides technical assistance to central office (CO), regional offices (ROs), contractors, etc., to solve problems by participating in meetings, answering inquiries, going onsite, doing special analyses, providing training, and refining instructions.
  • Prepares or directs the preparation of written communications/presentations to address complex and comprehensive correspondence, memoranda, briefing papers, option papers, speeches, and program proposals for senior leadership.
  • Provides project direction to lower-graded analysts, defines individual team members task assignments, reviews team members work for technical accuracy, and recommends employees’ technical training needs to the program manager.

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.
  • Time-in-Grade restrictions apply.
  • Selective Service: Males born after December 31, 1959, must be registered or exempt from Selective Service - http://www.sss.gov
  • One-year probationary period may be required
  • 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
  • All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choice

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF 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-15 , 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-14 grade level in the Federal government, obtained in either the private or public sector, to include:

1. Interpreting laws and policies related to Medicare Advantage payment, Part D payment, or drug pricing to provide guidance to management and stakeholders;
2. Advising senior management on the impact of Medicare Advantage, Part D payment, or drug pricing policy issues to support program decision-making and guide the implementation of new legislation;
3. Directing staff in the development of guidance documents, policy briefs, or standard operating procedures to implement Medicare Advantage, Part D, or drug pricing policy changes; AND
4. Analyzing drug pricing data, drug market trends, or legislative changes to develop policy recommendations that support Medicare Advantage or Part D payment and decision-making.

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.

Time-in-Grade: To be eligible, current Federal employees must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/12955129

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: Yes
Tour of Duty: Flexible
Recruitment Incentive: Not Authorized
Relocation Incentive: Not Authorized
Financial Disclosure: Required-OGE-450

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.

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 results of the online assessments required for this position. A Subject Matter Expert will 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):

  • Attention to Detail
  • Customer Service
  • Decision Making
  • Flexibility
  • Influencing/Negotiating
  • Integrity/Honesty
  • Interpersonal Skills
  • Learning
  • Reasoning
  • Self-Management
  • Stress Tolerance
  • Teamwork



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.

Centers for Medicare & Medicaid Services

The Department of Health & Human Services (HHS), Centers for Medicare & 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.

CMS' 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 in important national health care issues and be part of a dynamic, fast-paced, and highly visible organization. For more information on CMS, please visit: http://www.cms.gov/.

HHS has a critical preparedness and response mission: HHS protects the American people from health threats, researches emerging diseases, and mobilizes public health programs with domestic and international partners. In support of this mission, HHS offers its employees the opportunity to contribute their unique skills through voluntary temporary assignments to humanitarian emergencies or Departmental priorities countering new and emerging health, safety, and security threats.

Agency contact information

STAFF ACQUISITION (ASB)
Email
SAG-Mailbox@opm.gov
Address
Center for Medicare
7500 Security Blvd
Woodlawn, MD 21244
US

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