Program Manager

Office of Personnel Management • Washington, DC

4d • Onsite

About The Position

As a Program Manager in Healthcare and Insurance at the Office of Personnel Management, you will lead administrative program integrity operations that safeguard Federal health benefits programs. The role directs carrier compliance reviews, audit resolution, fraud prevention and detection activities, payment integrity oversight, corrective-action monitoring, contract-remedy support, and a multidisciplinary workforce, while collaborating with government and industry partners.

The position requires one year of specialized experience comparable to the GS-14 level for appointment at GS-15. There are no educational requirements. The position is based at an OPM-assigned office in Washington, DC and is not eligible for inclusion in a bargaining unit. A one-year trial period may be required.

Requirements

• Be a U.S. Citizen or National.
• Males born after December 31, 1959, must be registered with or exempt from Selective Service.
• Be suitable for Federal employment, as determined by a background investigation.
• Complete the initial online assessment and USAHire Assessment, if required.
• Report to an OPM-assigned office in Washington, DC.
• For GS-15, have at least 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, including all of the following: analyzing or overseeing health insurance program integrity and compliance activities addressing fraud, waste, abuse, improper payments, program vulnerabilities, or non-compliance; coordinating program integrity, compliance, referral, or corrective-action activities with relevant oversight organizations or partners; preparing referral packages, corrective-action recommendations, recovery or disallowance analyses, or contract-remedy options supported by findings; and developing policies, procedures, or performance measures supporting prevention, detection, and resolution of fraud, waste, abuse, and payment integrity risks in health insurance programs.
• Meet all qualification and eligibility requirements by the announcement closing date.

Responsibilities

• Direct administrative program integrity reviews involving potential fraud, waste, abuse, improper payments, control weaknesses, and other risks affecting Federal health benefits programs.
• Lead oversight of administrative reviews by assessing program documentation, audit findings, referrals, claims and payment data, and other relevant materials, and 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 review, referral, corrective-action, compliance, and contract-remedy activities 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 health insurance program integrity, accountability, and administrative oversight.
• Supervise a multidisciplinary workforce responsible for administrative program integrity reviews, carrier compliance oversight, audit resolution, payment integrity, corrective-action monitoring, referral coordination, and contract-remedy support.

Benefits

• Federal employees and their families have access to a comprehensive benefits package; specific benefits depend on position type and should be confirmed with the hiring agency.
• Relocation expenses may be available to current OPM employees.
• Incentive payments may be considered.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed