Centers for Medicare & Medicaid Services

Compensation

Full Description

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.