Health Insurance Specialist

Centers for Medicare & Medicaid Services•Bethesda, MD

About The Position

This position is in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Consumer Information and Insurance Oversight (CCIIO). The Health Insurance Specialist, GS-0107-14, leads technical reviews of Qualified Health Plan (QHP) submissions, improves certification processes and tools, develops operational guidance, and coordinates with CMS, States, issuers, and contractors to resolve complex issues. The role leads the review and analysis of QHP issuers and plans, particularly those in the Federally-facilitated Marketplaces (FFMs), to ensure compliance with PPACA provisions related to QHP certification. It partners with Center leadership and managers to evaluate QHP submission and review processes, develop solutions, and assess the impact of new initiatives. The specialist develops and updates standard operating procedures and sub-regulatory guidance for issuers regarding benefit review for plans offered in FFM markets, oversees technical assistance to issuers on QHP Certification Standards, including benefit and cost-sharing reviews, and serves as a technical expert on developing new QHP reviews and modifying existing ones. Applicants must be U.S. Citizens or Nationals and are subject to a background and suitability investigation. Time-in-grade restrictions apply, and a one-year probationary period may be required. Federal employees must receive salary payments by direct deposit. A regular and recurring reporting requirement to the CMS office listed in the announcement applies. The position is in a bargaining unit, with a flexible tour of duty and alternative work schedules potentially available at the manager's discretion. Recruitment and relocation incentives are not authorized; financial disclosure is not required.

Requirements

At least one year (52 weeks) of qualifying specialized experience equivalent to the GS-13 grade level in the Federal government, obtained in the private or public sector.
Experience developing or implementing policy, operational, or business requirements related to issuer compliance with Affordable Care Act (ACA)-related programs.
Experience reviewing and analyzing QHPs in the Federally-Facilitated Marketplaces to ensure compliance with QHP certification.
Experience overseeing technical assistance to issuers to ensure compliance with QHP Certification Standards, including benefit and cost-sharing reviews.
U.S. Citizenship or Nationality.
Current Federal employees must have completed at least 52 weeks at the next lower grade level to meet time-in-grade requirements.
Males born after December 31, 1959, must be registered for Selective Service or exempt.
Must meet all qualification requirements within 30 days of the announcement closing date.

Responsibilities

Lead review and analysis of QHP issuers and plans, particularly in the Federally-facilitated Marketplaces, to ensure compliance with PPACA provisions related to QHP certification.
Partner with Center leadership and managers to evaluate QHP submission and review processes, develop solutions, and assess the impact of new initiatives.
Develop and update standard operating procedures and sub-regulatory guidance instructing issuers on benefit review for plans offered in FFM markets.
Oversee technical assistance to issuers to ensure compliance with QHP Certification Standards, including benefit and cost-sharing reviews.
Serve as a technical expert across the Center on the operational development of new QHP reviews and modification of existing reviews.
Coordinate with CMS, States, issuers, and contractors to resolve complex issues.