This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), Provider Enrollment & Oversight Group (PEOG).
As a Health Insurance Specialist, GS-0107-9/11, you will serve as the focal point for all Medicare provider and supplier enrollment compliance functions, including identifying and reporting provider enrollment related vulnerabilities that may indicate fraud, waste, or abuse.
Summary
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), Provider Enrollment & Oversight Group (PEOG).
As a Health Insurance Specialist, GS-0107-9/11, you will serve as the focal point for all Medicare provider and supplier enrollment compliance functions, including identifying and reporting provider enrollment related vulnerabilities that may indicate fraud, waste, or abuse.
Reviews financial payment data and provider enrollment records to spot potential fraud, waste, and abuse (FWA). Uses established guidelines and analytical tools to evaluate issues, conduct studies, and identify program vulnerabilities.
Assists with developing, reviewing, and updating program integrity policies and regulations.
Identifies policy problems, recommends solutions, and contributes to decisions that may result in new or improved rules, criteria, or agency policies particularly around administrative sanctions and integrity initiatives.
Coordinates with Internal and external agencies on fraud, waste, and abuse (FWA) matters by compiling case documentation and factual summaries as well as engaging with senior officials across the healthcare industry, nonprofits, and contractors.
Prepares and delivers briefing materials, summary reports, and analytical findings for senior officials and provides technical advice to internal and external stakeholders on provider enrollment, program vulnerabilities, and integrity issues.
You must be a U.S. Citizen or National to apply for this position.
You will be subject to a background and suitability investigation.
Selective Service: Male born after December 31, 1959, must be registered or exempt from Selective Service - http://www.sss.gov
If you are selected for this position, the documentation that you present for purposes of completing the Department of Homeland Security (DHS) Form 1-9 will be verified through the DHS "E-Verify" System
All Federal employees are required to have Federal salary payments made by direct deposit to financial institution of their choice.
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-09, 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-07 grade level in the Federal government, obtained in either the private or public sector, to include:
Gathering and compiling financial program payment data, provider enrollment records, or related documentation to support investigations or inquiries involving fraud, waste, or abuse (FWA) in a health insurance program (e.g., Medicare, Medicaid, or Marketplace); AND
Supporting investigations, audits, or compliance activities related to health insurance programs through collaboration with internal teams, external agencies, contractors, or oversight bodies; AND
Analyzing federal health care statutes, regulations, and program integrity guidance to identify compliance concerns, program integrity issues, or policy matters related to provider enrollment or health insurance program operations, and preparing findings for reporting purposes.
- OR -
Substitution of Education for Experience: You may substitute education for specialized experience at the GS-09 level by possessing a Master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related to the position being filled.
- OR -
Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-07 grade level may be used to qualify applicants for positions at the grade GS-09. Therefore, only education in excess of 1 full year of graduate level education may be used to combine education and experience.
TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the "Required Documents" section below for the documentation required at the time of application.
In order to qualify for the GS-11, 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-09 grade level in the Federal government, obtained in either the private or public sector, to include:
Reviewing financial program payment data and provider enrollment records to identify potential indicators of fraud, waste, or abuse (FWA) in a health insurance program (e.g., Medicare, Medicaid, or Marketplace) and applying established analytical methods, protocols, and frameworks to assess FWA issues at the operational level; AND
Coordinating with internal teams, external agencies, contractors, and oversight bodies to support investigations, audits, or compliance and oversight activities related to health insurance programs, including preparing factual summaries and case documentation in support of multi-agency efforts; AND
Researching and applying federal health care statutes, regulations, or program integrity guidance to analyze and report on compliance concerns or program integrity issues related to provider enrollment or health insurance program operations.
- OR -
Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher level graduate education leading to such a degree or equivalent doctoral degree or LL.M., if related to the position being filled.
- OR -
Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at the grade GS-11. Therefore, only education in excess of a master's degree or its equivalent, or 2 full years of progressively higher-level graduate education leading to such a degree, may be used to combine education and experience.
TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the "Required Documents" section below for the documentation required at the time of application.
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.
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.
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):
Attention to Detail
Flexibility
Integrity/Honesty
Interpersonal Skills
Reading Comprehension
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.
RPL Applicants RPL applicants who are verified as registered for the same series, grade, and location as this vacancy announcement will be placed in one of the following categories based on category rating procedures:
Best Qualified - significantly exceeds the evaluation criteria.
Well Qualified - excels in the evaluation criteria.
Qualified - meets the minimum qualification requirements.
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; AND 3) Your latest performance rating and rating of record (if separate documents) showing your rating score as at least fully successful or equivalent
If you are found to be among the top-qualified candidates, you will be referred to the selecting official for employment consideration.
The category rating process does not add veterans' preference points 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.
1. Resumeshowing 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 12/31/59. 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). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips, visit: https://www.cms.gov/files/document/2026-required-documents.pdf
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. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.
3. College Transcripts. Although this position does not require a degree, you may substitute college credit in whole or in part for experience at specified grade levels. You must submit a copy of your transcript at the time of application in order to substitute your education for the required experience. If you do not submit a transcript, your education will not be considered in determining your qualifications for the position. You may submit an unofficial transcript or a list of college courses completed, indicating course title, credit hours, and grades received. An official transcript is required if you are selected for the position.
College Transcripts and Foreign Education: Applicants who have completed part or all of their education outside of the U.S. must have their foreign education evaluated by an accredited organization to ensure that the foreign education is comparable to the education received in accredited educational institutions in the U.S. For a listing of services that can perform this evaluation, visit the National Association of Credential Evaluation Services website. This list, which may not be all-inclusive, is for informational purposes only and does not imply any endorsement of any specific agency.
4. 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.
PLEASE NOTE: A complete application package includes the online application, resume, transcripts (if qualifying through education substitution or a combination of education and experience), and CMS required documents. Please carefully review the full job announcement, which includes the "Required Documents" and "How to Apply" sections. Failure to submit the online application, resume, transcripts (if applicable), and CMS required documents will result in your not being considered for employment.
If you are relying on your education to meet qualification requirements:
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
Your complete application package, as described in the "Required Documents" section, must be received by 11:59 PM ET on 06/03/2026 to receive consideration.
IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.
We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:
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 including month and year (e.g. June 2007 to April 2008)
Full-time or part-time status (include hours worked per week)
Salary
Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.
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.
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.
To verify the status of your application, log into your USAJOBS account (https://login.usajobs.gov/Account/), 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://help.usajobs.gov/how-to/application/status.
This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to hrinquiries@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.
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.
Center for Program Integrity
7500 Security Blvd
Woodlawn, MD 21244
US
Next steps
Once your online application is submitted, you will receive a confirmation notification by email. Within 30 business days of the closing date, 06/03/2026, 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.
1. Resumeshowing 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 12/31/59. 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). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips, visit: https://www.cms.gov/files/document/2026-required-documents.pdf
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. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.
3. College Transcripts. Although this position does not require a degree, you may substitute college credit in whole or in part for experience at specified grade levels. You must submit a copy of your transcript at the time of application in order to substitute your education for the required experience. If you do not submit a transcript, your education will not be considered in determining your qualifications for the position. You may submit an unofficial transcript or a list of college courses completed, indicating course title, credit hours, and grades received. An official transcript is required if you are selected for the position.
College Transcripts and Foreign Education: Applicants who have completed part or all of their education outside of the U.S. must have their foreign education evaluated by an accredited organization to ensure that the foreign education is comparable to the education received in accredited educational institutions in the U.S. For a listing of services that can perform this evaluation, visit the National Association of Credential Evaluation Services website. This list, which may not be all-inclusive, is for informational purposes only and does not imply any endorsement of any specific agency.
4. 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.
PLEASE NOTE: A complete application package includes the online application, resume, transcripts (if qualifying through education substitution or a combination of education and experience), and CMS required documents. Please carefully review the full job announcement, which includes the "Required Documents" and "How to Apply" sections. Failure to submit the online application, resume, transcripts (if applicable), and CMS required documents will result in your not being considered for employment.
If you are relying on your education to meet qualification requirements:
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
Your complete application package, as described in the "Required Documents" section, must be received by 11:59 PM ET on 06/03/2026 to receive consideration.
IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.
We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:
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 including month and year (e.g. June 2007 to April 2008)
Full-time or part-time status (include hours worked per week)
Salary
Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.
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.
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.
To verify the status of your application, log into your USAJOBS account (https://login.usajobs.gov/Account/), 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://help.usajobs.gov/how-to/application/status.
This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to hrinquiries@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.
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.
Center for Program Integrity
7500 Security Blvd
Woodlawn, MD 21244
US
Next steps
Once your online application is submitted, you will receive a confirmation notification by email. Within 30 business days of the closing date, 06/03/2026, 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.
