Centers for Medicare & Medicaid Services

Evaluate and develop health program integrity initiatives, review policies, and collaborate across agencies to safeguard healthcare programs. | Extensive experience in health policy, research, and data analysis, but lacks specific experience in health insurance program vulnerabilities, fraud detection, and policy proposal development. | At CMS, we believe that at the core of our organization are the employees who carry out the Agency’s vision of expanding coverage and improving health outcomes. About the role: This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), or Center for Consumer Information and Insurance Oversight (CCIIO). As a Health Insurance Specialist (Program Integrity), referred to here as Program Integrity Analyst (Health Insurance), you will develop, evaluate, and implement a wide range of program integrity initiatives and reviews to support CMS' lines of business. Your next career move could change millions of lives. Are you ready? Salary: $90,925 to - $118,204 per year Where we're hiring: • Atlanta, GA • Philadelphia, PA • Woodlawn, MD What you'll do: • Review and evaluate financial program payments, identify areas of potential non-compliance, investigate fraud, waste, and abuse allegations, and conduct thorough program integrity reviews to safeguard Agency programs. • Review and comment on new or proposed policy revisions, regulations, administrative sanctions, and legislation to determine their impact on contractor/provider operations and program safeguarding effectiveness. • Study healthcare financing or delivery systems data and conduct complex analytical projects involving coordination across organizational lines. • Establish and maintain effective working relationships with diverse contacts, including State officials, government agency representatives, and healthcare industry officials. • Apply extensive knowledge of Titles XVIII and XIX of the Social Security Act, healthcare laws (including Title XVII of the Public Health Service Act), and regulations to make recommendations for improving program operations. Qualifications: In order to qualify for the GS-13, you must meet the following: 1) Evaluating health insurance program vulnerabilities to detect fraud, waste, or abuse; 2) Collaborating across organizational lines on investigations, audits, or oversight of health insurance programs; AND 3) Proposing policy changes relating to program integrity. 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. You MUST apply through USAJOBS by 2/02/2026 to be considered.

Evaluate and develop policies related to healthcare programs, monitor contractor performance, and analyze healthcare legislation impacts. | Extensive experience in health services research, policy analysis, and data management, with leadership in multidisciplinary teams. | Summary This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicaid and CHIP Services (CMCS). As a Health Insurance Specialist (Program Contract Manager), GS-0107-13, you will serve as an expert in developing, evaluating, and implementing policies for Agency healthcare programs, and propose operational modifications based on healthcare industry changes and beneficiary needs. Duties Help • Serve as an expert in the development, evaluation, and implementation of policies related to administering, reviewing and evaluating contracted stakeholders that participate in Agency health care delivery and quality or payment programs. • Identify and propose modifications to operations to reflect changes or trends in the health care industry program objectives and needs of beneficiaries. • Evaluate proposed, modified, or new legislation and regulations to assess impact on national health delivery, quality, or payment programs. • Analyze internal policies, processes, and procedures to assure increased efficiency in operations and implement those policies, procedures, and processes to resolve problems and improve internal operations. • Identify vulnerabilities in program requirements, implement instructions and guidelines to safeguarding program expenditures. Requirements Help 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. 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-13, 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) Providing procurement planning, execution, monitoring and technical assistance for Contracting Officer Representative (COR) activities for a national healthcare program (i.e. Medicaid, CHIP, Marketplace); (2) Monitoring contractors who support national healthcare programs and maintain related databases, such as master utilization records and history files; (3) Conducting analytical studies by interpreting health care program issues related to contract administration functions; AND (4) Coordinating responses to government inquiries regarding health care program issues requiring corrective action plans. 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 or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year 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/12873689 Education This job does not have an education qualification requirement. Additional information 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 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 CTAP eligibility is on OPM's Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp. Expand Hide additional information 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. Benefits Help 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. Review our 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.

Support the Director and Deputy Director in communications planning, preparing materials, coordinating projects, and advising on personnel issues. | At least one year of specialized experience equivalent to GS-12 level in federal government involving collaboration with senior management, making recommendations, and preparing technical and non-technical documents. | Summary This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Communications, Front Office. As a Special Assistant, GS-0301-13, you will work closely with the Director and Deputy Director as a Special Assistant, supporting the entire range of activities for the OC Front Office. Duties Help • Actively participates with the Director and Deputy Director and OC senior staff in the review and assessment of communications-related programs. • Assists in agency-wide communications planning, coordination, and clearances. • Prepares materials, presentations, reports, briefing notes, and talking points for the Director/Deputy Director. • Plans, coordinates, and conducts special assignments, and projects. • Provides advice and counsel to the Director and Deputy Director on personnel issues including awards, selection criteria, and developing position descriptions. Requirements Help 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. Qualifications ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF 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) Collaborating with the senior management or senior officials to complete projects; (2) Making recommendations to senior management or key stakeholders; AND (3) Preparing a variety of technical and non-technical documents for use by internal and external audiences. 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/12793121 Education This job does not have an education qualification requirement. Additional information Bargaining Unit Position: No 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. Expand Hide additional information 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. Benefits Help 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. Review our 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.