Supervisory Health Insurance Specialist (Division Director)

Summary

Department of Health & Human Services, Centers for Medicare & Medicaid Services, Center for Medicare, Medicare Enrollment & Appeals Group (MEAG), Division of Appeals Policy (DAP). As a Supervisory Health Insurance Specialist, GS-0107-15, serves as the Division Director with overall responsibility for directing, coordinating, and integrating the functions of staff with the work of other organizations in the Center and throughout the Agency, and/or external-to-CMS groups or interests.

Duties

• Planning and assigning work, establishing priorities, evaluating performance, resolving employee concerns, approving personnel actions, and identifying training and development needs.
• Directing the analysis, development, interpretation, and implementation of legislation, regulations, policies, and procedures governing Medicare appeals, grievances, and beneficiary dispute resolution.
• Overseeing Medicare Advantage and Part D appeals operations involving regional offices, Independent Review Entities, the Office of Medicare Hearings and Appeals, and the Departmental Appeals Board.
• Leading the development and administration of standardized beneficiary notices and policies that safeguard Medicare beneficiary rights, protections, and financial liability requirements.
• Developing and approving manual instructions, rulings, change requests, technical direction letters, and policy guidance concerning appeals, grievances, and dispute resolution processes.
• Representing CMS before HHS, OMB, congressional staff, federal agencies, contractors, health plans, provider organizations, beneficiary groups, and other stakeholders.
• Evaluating division operations, implementing process improvements, recommending staffing and budget resources, and ensuring work products meet established quality, timeliness, and regulatory requirements.
• Coordinating with CMS components, legal counsel, adjudicatory entities, and technology teams to resolve operational issues and improve Medicare appeals systems and workflows.

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-15 , 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-14 grade level in the Federal government, obtained in either the private or public sector, to include: 1. Overseeing work activities of teams responsible for implementing federal healthcare programs; 2. Directing the development of regulatory proposals and sub-regulatory guidance for federal healthcare policy; And 3. Collaborating with provider groups, managed care and prescription drug plans, Medicare contractors, States, and other stakeholders on continuous improvement of healthcare programs. 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/13055949

How to apply

Please read the entire announcement and all the instructions before you begin an application. To apply and be considered for this position, you must complete all required questionnaires, assessments and submit all required documentation as specified in the How to Apply and Required Documents sections. The complete application package must be submitted by 11:59 PM (ET) on 09/18/2026. IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION. We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Determining length of general or specialized experience is dependent on the below information and failure to provide ALL information WILL result in a finding of ineligible. Official Position Title (include series and grade if Federal job) Duties (be specific in describing your duties) Employer's name and address Supervisor name and phone number Start and end dates by month and year (e.g. June 2007 to April 2008) Full-time or part-time status (include hours worked per week) Salary The application process is as follows: Click the Apply button. Answer the questions presented in the application and attach all necessary supporting documentation. Click the Submit Application button prior to 11:59 PM (ET) on 09/18/2026. If you are required to complete any USA Hire Assessments, you will be notified after submitting your application. The notification will be provided in your application submission screen and via email. The notification will include your unique assessment access link to the USA Hire system and the completion deadline. Additionally, in USAJOBS you can click "Track this application" to return to your assessment completion notice. Access USA Hire using your unique assessment link. Access is granted through your USAJOBS login credentials. Review all instructions prior to beginning your assessments. You will have the opportunity to request a testing accommodation before beginning the assessments should you have a disability covered under the Rehabilitation Act of 1973 as amended. Set aside at least 3 hours to take the USA Hire Assessments; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue later, you can re-use your unique assessment link. Your responses to the USA Hire Assessments will be reused for one year (in most cases) from the date you complete an assessment. If future applications you submit require completion of the same assessments, your responses will be automatically reused. Visit the USA Hire Applicant Resource Center for practice assessments and assessment preparation resources at https://support-usahire.opm.gov/hc/en-us. To update your application, including supporting documentation: During the announcement open period, return to your USAJOBS account, find your application record, and click Edit my application. This option will no longer be available once the announcement has closed. To view the announcement status or your application status: Visit https://help.usajobs.gov/how-to/application/status. Your application status page is where you can view your application status, USA Hire assessment completion status, and review your notifications sent by the hiring agency regarding your application. Commissioned Corps Officers (including Commissioned Corps professionally boarded applicants) who are interested in applying to this position must send their 1-page cover letter and 2-page ONLY professional resume (not PHS Curriculum Vitae) to [email protected] in lieu of applying through this announcement. The resume should specifically explain how you are qualified for this position and draw specific attention to your skills and experiences that demonstrate these qualifications. Also, send any transcripts, licenses, or certifications as requested in this announcement. Please send all documents in 1 PDF file. In the subject line of your e-mail, include only the Job Announcement Number. In the body of your e-mail, include your current rank name and serial number. Failure to provide this information may impact your consideration for this position. Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s)of the location identified in this announcement. By applying, you agree to have your application shared with any interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.