Health Insurance Specialist (Program Policy)

Created at: August 27, 2025 00:15

Company: Centers for Medicare & Medicaid Services

Location: Boston, MA, 2101

Job Description:

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation, (CMMI), Patient Care Models Group (PCMG). As a Health Insurance Specialist (Program Policy), GS-0107-13, you will perform program policy work related to national health insurance programs, such as Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and Marketplace Exchange/private health insurance.
ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT. Your resume 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 grade level, 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. Leading teams or work groups that conduct analysis of national and/or state health insurance programs to propose policy modifications. 2. Coordinating with federal and/or state officials to implement policy changes related to health insurance programs. and 3. Presenting recommendations or conclusions based on the analysis and evaluation of health insurance programs that describe feasible options or possible 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/12789216
Serve as an expert in interpreting statute and developing Federal regulations, policy statements, and other program guidance relating to national health insurance programs.
Conduct analysis of policy issues and topics by researching background information, the origin of laws, and the intended impact in order to make effective policy recommendations.
Develop and review health care policies and legislation in order to draft related policy documents, regulations, procedures and guidance to states.
Evaluate and analyze the impact of new or revised changes to legislation before the Congress pertaining to any CMS program.
Develop, implement, and maintain operational requirements, including standard operating procedures, as well as databases to manage and analyze programmatic information such as routine and ad hoc report, deliverables, and programmatic documentation


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