Claims Management Program Analyst (O-4 Billet) Non-Supervisory

Summary

The Claims Management Program Analyst at IHSC manages claims, provider recruitment, and compliance with healthcare standards for ICE detainees. Responsibilities include program evaluation, training, and support for clinical care. Requires healthcare management experience, knowledge of claims processes, and ability to travel. This position is only open to USPHS officers and Call to Active Duty (CAD) candidates.

Duties

• DUTIES AND RESPONSIBILITIES: Serves in the capacity as a Claims Management Program Analyst; handles and assists program activities and policies related to claims management, and provider recruitment. Assumes leadership role as acting claims management program analyst lead when necessary. Serves as CMP representative between IHSC, third-party administrator, CBP components, and ICE ERO components in coordinating care and recruitment of off-site community provider for illegal aliens. Assist in developing, evaluating, and coordinating CMP related functions to ensure adherence to industry practices in eligibility verification, authorization of care, claims management denials and appeals to minimize adverse outcomes related to timely filing and maintaining a Provider Network to provide quality specialty care to illegal aliens. Duties include assisting in day-to-day managing, assessing, planning, developing, implementing, and evaluating assigned programs. Incumbent assists with reviews of policies. Incumbent ensures compliance with program regulations (e.g., appropriateness of health care and services based on regulatory, reimbursement requirements, evidence-based national care guidelines and evidence-based practices), maintains records per program policy, coordinates and, or manages programs within immediate organizational component. Communicates and collaborates with individuals or groups from outside the agency, including consultants and contractors. Work purpose is primarily to collaborate; supply advice; explain, interpret, and seek support for methods, policies and programs; or render a service of a moderately complex nature requiring a moderate amount of explanation and tact (e.g., support for budget). Liaise regionally and, or, nationally with applicable stakeholders internal and external stakeholders (e.g., U.S. Customs and Border Patrol, third party administrator and off-site community providers) regarding medical claims processes, trainings, and principles. Provides guidance to the respective ICE custody, and medical staff members of facilities in which and ICE illegal aliens are held regarding ICE policies, reporting requirements, and applicable ICE detention standards. Judgmental failure can result in ineffective or inappropriate use of resources and delays in meeting public health objectives of the office or agency. This may also impair the development of systems, affect the work of subordinate employees, and compromise the delivery of other administrative and personnel services. Travel may be required - estimated 15% Travels TDY as needed to provide clinical care support at IHSC-staffed detention facilities with critical staffing needs. Performs other duties and responsibilities as assigned.

Qualifications

PHYSICAL DEMANDS: Sitting and/or standing for extended periods of time [6-8 Hours]. Performing repeated bending motion. Average manual dexterity for computer operation. Phone use for extended periods of time. Required to walk unaided at a normal pace for up to 5 minutes and maintain balance. Required to jog/fast walk up to 1⁄4 mile. Required to perform CPR/emergency care standing or kneeling. Must have the ability to assist sick, injured, or aging illegal aliens or staff exiting the building (may require lifting, dragging, wheeling, or carrying someone who weighs significantly more than oneself).

Education

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES: Incumbent must possess a minimum of three years of professional experience relevant to the officer's category. Of the total professional experience, officer must possess at least two years of experience related to program management, administration, Healthcare management, finance or medical claims is preferred. Qualifying degree for the officer's category from an accredited institution If the incumbent holds a clinical license, it is the responsibility of the incumbent to fulfill the obligation(s) of their licensing or certifying body to maintain status. The agency may require the incumbent performs clinical activities with the scope of clinical license in times of critical needs within the agency. If in a clinical discipline and as directed and approved by his/her supervisors, the incumbent may perform clinical duties of their profession in Federal health care facilities. Such direction is documented via a memorandum of assignment and is filed in the eOPF. Well-developed knowledge and skills in the areas of claims management and medical necessity. Knowledge of medical, administrative, ethical, and legal requirements and standards related to healthcare delivery. Should possess some knowledge of International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), current procedural terminology (CPT), diagnosis-related group (DRG), and other Centers for Medicare and Medicaid Services (CMS) coding/billing requirements. Experience utilizing and navigating electronic health records and other web-based application programs. Ability to critically analyze situations, data, and information, and be able to develop and pose probing questions, identify problems, and make recommendations towards their resolution. Maintains clinical professional skills via continuing education opportunities. Computer literate on Microsoft Office applications, and Sharepoint applications.

How to apply

To apply for this position, you must submit the required documentation outlined under the REQUIRED DOCUMENTS section below. The complete initial Application must be submitted by 11:59 PM (EST) on 09/30/2026. PLEASE NOTE: If your materials are not received by the closing date, your application will be evaluated solely on the information available and you may not receive full consideration or may not be considered eligible. Also, if you do not provide a valid email address, you may not be notified of the outcome of your application. To begin the process, click the Apply Online button to create an account or log into your existing USAJOBS account. Follow the prompts to complete the occupational questionnaire. Please ensure you click the Submit My Answers button at the end of the process. Note: To check the status of your application or return to a previous or incomplete application, log into your USAJOBS account, select Application Status, and click on the more information link under the application status for this position. Applications and supporting documentation will not be accepted by mail or email. If you need further assistance, contact the Human Resources Office representative listed on this announcement at least one day prior to the closing date for further instructions.