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Health Insurance Specialist

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Program Integrity (CPI)

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), Data Analytics and Systems Group (DASG).

As a Health Insurance Specialist, GS-0107-14, you will serve as a technical authority and advisor for the group in the development of program policy and operational procedures related to the implementation of analytics and data systems strategies to support program integrity activities.

Overview

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Accepting applications
Posted yesterday · Apply by 06/04/26
Due by 11:59 p.m. ET on June 4, 2026
Location
1 vacancy in the following location:
Work site options
Telework eligible
Yes—as determined by the agency policy.
Remote job
No
Relocation expenses reimbursed
No
Salary
$143,913 - $187,093 per year
Pay scale & grade
GS 14
Promotion potential
14
Pay scale and grade determines the salary of the job.
Work schedule
Full-time
Travel Required
Occasional travel - You may be expected to travel for this position.
Appointment type
Permanent
Occupations and job series
Supervisory status
No
Federal service type
This job is in the Competitive Service
Represented by a union
Yes
Drug test
No
Security clearance
Not Required
Position sensitivity and risk
Moderate Risk (MR)
Jobs require a background check and some require a security clearance. The type depends on the job.
Background check type
Financial disclosure required
No
Some jobs require financial disclosure to identify conflicts of interests.
Announcement number
CMS-CPI-26-12972671-IMP
Control number
870910200

This job is open to

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Clarification from the agency

Career Transition Assistance Plan Eligibles; OR Current Centers for Medicare and Medicaid Services Permanent Career and Career-Conditional Employees

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Duties

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  • Supports DASG by developing, implementing, and overseeing systems like the Fraud Prevention System (FPS) and predictive analysis tools.
  • Develops short-term and long-term project plans, identifies milestones, and resolves bottlenecks while executing all phases of work with limited supervisory oversight.
  • Contributes to operating plans, budget justifications, and acquisitions artifacts (e.g., acquisition plans, etc.)
  • Represents CMS as a technical advisor by providing assistance to Federal and State agencies and private sector organizations and resolving policy-related issues and conflicts.
  • Produces written materials to support program operations, including briefing documents, performance dashboards, reports, and issue papers for senior leadership and external stakeholders.

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-14, 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-13 grade level in the Federal government, obtained in either the private or public sector, to include:

  1. Participating in the development or maintenance of Information Technology (IT) platforms and data access methodologies for detection of fraud, waste, and abuse in the Medicare and Medicaid programs; AND
  2. Conducting special Program Integrity (Pl) studies focused on cross program issues; AND
  3. Preparing briefings and reports for senior management.


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/12972671

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: 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.

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
  • Customer Service
  • Decision Making
  • Flexibility
  • Influencing/Negotiating
  • Integrity/Honesty
  • Interpersonal Skills
  • Learning
  • 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.

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 Program Integrity
7500 Security Blvd
Woodlawn, MD 21244
US

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