Program Manager

Office of Personnel Management•Washington, DC

4d•Onsite

About The Position

The Program Manager is part of the Office of Personnel Management’s Healthcare and Insurance program. The role leads administrative program integrity operations that safeguard Federal health benefits programs. It directs carrier compliance reviews, audit resolution, fraud prevention and detection, payment integrity oversight, corrective-action monitoring, contract-remedy support, and the work of a multidisciplinary team, while collaborating with government and industry partners.

Requirements

For GS-15, one full year (52 weeks) of specialized experience comparable in scope and responsibility to the GS-14 grade level or pay band, gained in the public or private sector.
Experience analyzing or overseeing health insurance program integrity and compliance activities addressing potential fraud, waste, abuse, improper payments, vulnerabilities, or non-compliance.
Experience coordinating program integrity, compliance, referral, or corrective-action activities with oversight organizations, legal counsel, contracting officials, health care organizations, carriers, or program offices.
Experience preparing referral packages, corrective-action recommendations, recovery or disallowance analyses, or contract-remedy options supported by program integrity findings.
Experience developing policies, procedures, or performance measures supporting prevention, detection, and resolution of fraud, waste, abuse, and payment integrity risks in health insurance programs.
Merit promotion applicants must meet the time-in-grade requirement: one year at the GS-14 grade level for GS-15.
Must meet all qualification and eligibility requirements within 30 days of the announcement closing date.
Must be a U.S. Citizen or National.
Males born after December 31, 1959, must be registered for or exempt from Selective Service.
Must be suitable for Federal employment, as determined by a background investigation.
Must complete the initial online assessment and USAHire Assessment, if required.
Must report to an OPM-assigned office.
May be required to successfully complete a probationary period.

Responsibilities

Direct administrative program integrity reviews involving potential fraud, waste, abuse, improper payments, control weaknesses, and other risks affecting Federal health benefits programs.
Lead administrative review oversight by evaluating program documentation, audit findings, referrals, claims and payment data, and other relevant materials; recommend corrective actions, recoveries, disallowances, sanctions-implementation steps, or other administrative remedies.
Oversee health insurance carriers’ compliance with contractual and regulatory requirements by directing compliance reviews, validating corrective actions, and resolving findings through appropriate administrative processes.
Analyze program integrity trends, claims data, audit results, carrier submissions, and risk indicators to identify vulnerabilities, improper payment risks, control weaknesses, and opportunities to strengthen fraud prevention and detection.
Coordinate administrative reviews, referrals, corrective actions, compliance activities, and contract remedies with Offices of Inspector General, legal counsel, contracting officials, program offices, carriers, health care organizations, and other oversight partners.
Develop policies, procedures, documentation standards, referral protocols, corrective-action processes, and performance measures to improve program integrity, accountability, and administrative oversight.
Supervise a multidisciplinary workforce responsible for program integrity reviews, carrier compliance oversight, audit resolution, payment integrity, corrective-action monitoring, referral coordination, and contract-remedy support.