Health Insurance Specialist

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Clinical Standards and Quality (CCSQ) Survey and Operations Group (SOG). As a Health Insurance Specialist, GS-0107-7/9, you will prepare and develop survey and certification policies, procedures and compliance oversight for healthcare providers and suppliers.

Duties

• Examine and provide suggestions for modifications to existing operating policy and procedures relating to the survey and certification program.
• Conduct analytical studies and evaluate the effectiveness of program initiatives by gathering, organizing, and interpreting data. Make recommendations supported by facts and background.
• Assist in overseeing the enforcement of regulatory requirements for health, safety and quality of healthcare facilities.
• Respond to routine inquiries regarding program related activities to a variety of internal and external stakeholders.
• Complete administrative duties as needed to ensure the smooth operation of the organization.
• Develop short-term or long-range project plan to ensure logistics are handled efficiently, identifying potential bottlenecks, and resolving issues within the scope of authority.

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 receiving further consideration. In order to qualify for the GS-07, you must meet one of the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-05 grade level in the Federal government, obtained in either the private or public sector, to include: 1. Assist in conducting analytical studies to evaluate the effectiveness of program initiatives by gathering, organizing, and interpreting data; 2. Assist in the development of short-term or long-range project plans to streamline logistics and improve operational efficiency and 3.Collaborate with internal and external stakeholders to support effective program policy implementation -OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-07 grade level by possessing at least 1 full academic year of graduate level education. One year of full-time graduate education is considered to be the number of credit hours that the school attended has determined to represent 1 year of full-time study. If that information cannot be obtained from the school, 18 semester hours should be considered as satisfying the 1 year of full-time study requirement. Part-time graduate education is creditable in accordance with its relationship to a year of full-time study at the school attended. -OR- Superior Academic Achievement: A bachelor's degree from an accredited college or university AND one of the following provisions of superior academic achievement: NOTE: If you are claiming S.A.A. you must provide an unofficial transcript at the time of application that documents this claim: A grade-point average of "B" (3.0 or higher on a 4.0 scale) for all completed undergraduate courses or those completed in the last two years of undergraduate study. For example, 2.95 is rounded to 3.0, and 2.94 is rounded to 2.9. A grade-point average of 3.5 or higher on a 4.0 scale for all required courses completed in your major field of study, or those required courses in your major completed in the last two years of your undergraduate stud. Rank in the upper one-third of your class in the college, university, or major subdivision. Membership in a national honor society (other than freshman honor societies) recognized by the Association of College Honor Societies. -OR- Combination of Experience and Education: Equivalent combinations of successfully completed post-high school education and experience may be used to meet total experience requirements at the GS-07 grade level. The percentage of your total qualifying experience the education must equal to 100% to qualify for this grade. In order to qualify for the GS-09, 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-07 grade level in the Federal government, obtained in either the private or public sector, to include: 1. Conducting analytical studies to evaluate the effectiveness of program initiatives by gathering, organizing, and interpreting data; 2. Developing short-term or long-range project plan to ensure logistics are handled efficiently; and 3. Responding to routine inquiries regarding program related activities to a variety of internal and external stakeholders. - OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-09 level by possessing a Master's or equivalent graduate degree or 2 full years of progressively higher-level graduate education leading to such a degree or LL.B. or J.D., if related to the position being filled. - OR - Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-07 grade level may be used to qualify applicants for positions at the grade GS-09. Therefore, only education in excess of 1 full year of graduate-level education may be used to combine education and experience. TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the "Required Documents" section below for the documentation required at the time of application. 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 or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year 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/13059015

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 09/15/2026. 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 09/15/2026. 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. You may update your application documents and some questions related to your personal information at any time during the announcement open period. Upon application, you may be provided a testing window to complete additional assessments. This testing window may stipulate a completion deadline before the announcement closes. It is your responsibility to complete the additional online assessments within the timeline provided to remain in consideration for this vacancy announcement. Failure to complete the online assessments within the testing window for this announcement will not preclude you from being considered for and completing the online assessments during a testing window on a future announcement. 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 interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.