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Claims Management and Customs and Border Protection Program Analyst (O-5 Billet) Non-Supervisory

Department of Homeland Security
Immigration and Customs Enforcement
ICE Health Service Corps (IHSC)
This job announcement has closed

Summary

The Claims Management and U.S. Customs and Border Protection Program Analyst supports DHS ICE Health Service Corps' Health Plan Management Unit. Responsibilities include claims adjudication, provider recruitment, training, fraud prevention, and liaison duties with CBP, HSI, and third-party administrators.

This position is only open to USPHS officers who are currently IHSC employees.
USPHS Call to Active Duty (CAD) candidates are not eligible for this position.

Overview

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Reviewing applications
Open & closing dates
10/28/2025 to 11/11/2025
Salary
$1 to - $150,000 per year

Please note that the salary is dependent on the officer's rank, years in service, and location of duty station.

Pay scale & grade
CC 5
Locations
1 vacancy in the following locations:
Washington, DC
Location Negotiable After Selection
Remote job
No
Telework eligible
No
Travel Required
25% or less - You may be expected to travel for this position.
Relocation expenses reimbursed
Yes—You may qualify for reimbursement of relocation expenses in accordance with agency policy.
Appointment type
Permanent
Work schedule
Full-time
Service
Excepted
Promotion potential
None
Job family (Series)
Supervisory status
No
Security clearance
Other
Drug test
Yes
Position sensitivity and risk
Critical-Sensitive (CS)/High Risk
Trust determination process
Financial disclosure
No
Bargaining unit status
No
Announcement number
IHSC-HPMU-CMCBP-O5-NS-2026
Control number
848990700

This job is open to

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Internal to an agency

Current federal employees of the hiring agency that posted the job announcement.

Clarification from the agency

Applicants must be a current USPHS Commissioned Corps Officer who works at IHSC. USPHS Call to Active Duty (CAD) candidates are not eligible for this position. Civilians are not eligible for this position.

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Duties

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DUTIES AND RESPONSIBILITIES:

  1. Serves as one of the primary points of contact and liaison to the third-party administrator on issues relating to medical claims processing and resolution and provider reimbursement.
  2. Serves as one of the primary points of contact and liaison to the U.S. Customs and Border Patrol, Office of Field Operations (OFO) and Homeland Security Investigations (HSI).
  3. Provides oversight and consultation while reviewing, approving, denying, and adjudicating Medical Payment Authorization Requests for reimbursable healthcare services submitted by CBP, OFO, and HSI.
  4. Requests MedPARs for reimbursable health care services and medical claims review.
  5. Collaborates with the Claims Management Program to reconcile and resolve denied community provider claims and/or appeals.
  6. Provides oversight and consultation to CBP for recruitment and enrollment of providers into the IHSC provider network.
  7. Liaise regionally and, or, nationally with applicable internal and external stakeholders (CBP, and third-party administrator, off-site community providers) regarding medical claims processes, trainings, and principles.
  8. Provides orientation, training, and guidance to CBP and ICE custody staff responsible for overseeing individuals detained by CBP and ICE. This includes ensuring adherence to ICE policies, reporting requirements, and applicable ICE detention standards.
  9. Identifies potential areas for improvement in the managed care delivery system that warrants re-engineering to create efficiencies, marketing and increase cost containment controls, and ensure the provision of necessary and appropriate health care.
  10. Supports systems and mechanisms to identify potential fraud, waste and abuse.
  11. Evaluates, assesses, and recommends reimbursement methodologies and procedures.
  12. Assists third-party administrator when necessary in coordinating and obtaining information pertaining to Medical Provider Authorization Requests (MedPARs) or eligibility in the alien tracking system.
  13. Develops specific goals and plans to prioritize, organize, and accomplish positive outcomes.
  14. TDY as needed to provide clinical care support at IHSC-staffed detention facilities with critical staffing needs.
  15. Travel may be required- minimal (<15%)
  16. Performs other duties as assigned.

Requirements

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Conditions of employment

  • You must be a U.S. citizen to apply for this position.
  • You must successfully pass a background investigation.
  • You must successfully pass a drug screen.
  • Males born after 12/31/59 must certify registration with Selective Service.
  • Requirements by Closing Date: Unless otherwise noted, you must meet all requirements by the closing date of the announcement.
  • Service Remaining Requirement Agreement: Upon appointment to this position, officers will be required to serve a new 18-month commitment to IHSC .
  • ASSIGNMENT PAY AGREEMENT: You must not have a current Assignment Pay Agreement. However, if you have a current Assignment Pay Agreement, it must be fulfilled within 90 days of your application submission.
  • Applicants must be a current USPHS Commissioned Corps Officer who works at IHSC. USPHS Call to Active Duty (CAD) candidates are not eligible for this position. Civilians are not eligible for this position.
  • PHS officers must participate in IHSC TDY On-Call Schedule (ITOS.) ITOS is either an entire month or two 16-day periods a year where, depending on the needs of the agency, the officer is required to be available to serve.

Qualifications

PHYSICAL DEMANDS:

  1. Sitting and/or standing for extended periods of time (6-8 hours).
  2. Performing repeated bending motion.
  3. Average manual dexterity for computer operation.
  4. Phone use for extended periods of time.
  5. Required to walk unaided at a normal pace for up to 5 minutes and maintain balance.
  6. Required to jog/fast walk up to ¼ mile.
  7. Required to perform CPR/emergency care standing or kneeling.
  8. Must have the ability to assist sick, injured, or aging detainees or staff exiting the building (may require lifting, dragging, wheeling, or carrying someone who weighs significantly more than oneself)

Education

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES:

  1. Bachelor's degree in business administration, Finance, Health Care Management or related field preferred; or a graduate degree with extensive experience in claims management, benefit, third-party administration, or contract management preferred.
  2. It is the responsibility of the incumbent to fulfill the obligation(s) of their licensing or certifying body to maintain currency. This position may be required to perform clinical activities with the scope of clinical license in times of critical needs within the agency.
  3. Minimum 3 years of experience working with health care organizations, third-party administrators, or health care providers.
  4. Performs tasks requiring the highest level of independence; exhibits preparation and flexibility to adapt to unusual circumstances requiring variations in approach, and in the presence of incomplete or conflicting data related to MedPARs and claims adjudication.
  5. Ability to navigate in an electronic work environment including , electronic health records, web-based training and communications.
  6. Ability to establish and maintain positive working relationships in a multidisciplinary environment. Establish contact with people in other federal departments or outside the federal government.
  7. Requires virtual face to face contact and telephone dialogue on a routine basis.
  8. Should possess some knowledge of International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), current procedural terminology (CPT), diagnosis-related group (DRG), and other Centers for Medicare and Medicaid Services (CMS) coding/billing requirements.
  9. Ability to provide technical advisory services to customers on matters related to medical claims processing, provision of special medical care, and the purchase or rental of durable medical goods.
  10. Demonstrated ability to maintain patient confidentiality and the confidentiality of all records in compliance with the Privacy Act and HIPAA regulations, exercising sound judgment and discretion in all work activities.
  11. Skill in applying analytical and evaluative methods and techniques to issues concerning the efficiency and effectiveness of providing health care, and ensuring on-time and accurate billing and payment.
  12. Ability to manage multiple tasks and prioritize based on mission needs and urgencies.
  13. Skills in applying analytical and evaluative methods and techniques to issues concerning the efficiency and effectiveness of providing health care, and ensuring on-time and accurate billing and payment.
  14. Flexibility and ability to adapt to sudden changes in schedules and work-related requirements.
  15. Knowledge and proficiency in MS Office Applications, Excel, Outlook, MS Teams and SharePoint.
  16. Completes all initial, annual and ad hoc training as required/assigned.
  17. Maintains patient confidentiality, and confidentiality of all records, in compliance with the Privacy Act and HIPAA regulations in all work activities.
  18. Other assigned duties

Additional information

This position is located within the Department of Homeland Security (DHS), Immigration and Customs Enforcement (ICE), Enforcement and Removal Operations (ERO), ICE Health Service Corps (IHSC), IHSC Deputy Assistant Director for Healthcare Compliance, Health Plan Management Unit, Claims Management Program. The incumbent will report directly to the IHSC supervisory U.S. Customs and Border Protection Program Analyst. This is a nonsupervisory position.

HPMU's focus is on the claims management program through the governance of a provider network, claims adjudication, referral management and utilization management. HPMU collaborates with a third-party administrator, and off-site community providers to establish letters of understanding with IHSC. HPMU also works jointly with IHSC stakeholders: pharmacy; dental; Behavioral Health Unit; Field Medical Coordination Unit; and IHSC headquarters to meet mission initiatives. HPMU trains field medical coordinators, and referral coordinators to improve processes related to the recruitment and retention of off-site community providers and claims process workflows to decrease claims denials and increase the number of paid claims. Responsible for being a liaison between IHSC, U.S. Customs and Border Patrol (CBP), Office of Field Operations (OFO) and Homeland Security Investigations (HSI), off-site community providers and third-party administrator.

IHSC has a multi-sector, multidisciplinary workforce of more than 1400 employees, including U.S. Public Health Service (PHS) commissioned officers, federal civil servants, and contract staff. In Fiscal Year (FY) 2024, IHSC provided direct care to more than 138,000 illegal aliens housed in 18 facilities throughout the nation to include medical, dental, and mental health care, and public health services. In FY 2024, IHSC oversaw compliance with health-related standards for 186,900 illegal aliens housed in 129 non-IHSC-staffed facilities, totaling almost 45,500 beds.

SUPERVISORY CONTROLS:
The Claims Management and U.S Customs and Border Protection Program Analyst works under the general supervision of the IHSC Health Plan Management Unit, Supervisory medical claims and U.S. Customs and Border Patrol Program Analyst

The incumbent plans and organizes his/her own work, determines the sequence of assignments, selects, and develops methods, and seeks assistance from experts only rarely. Assignments are usually long-term, recurring, or broadly defined. Work is reviewed for feasibility, compatibility with other work, and effectiveness in meeting requirements or expected results.

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.

We will review your resume and supporting documentation to ensure you meet the minimum qualification requirements. You may be selected for an interview at the hiring authority's discretion. You will be notified of selection or non-selection.

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